Online Referral Form
The information in this section is for dentists / physicians only.
Implant Systems we use are Nobel Biocare, Astra, Straumann and Southern Dental Implants. Please indicate on the referral form your preference. Please email / call our office if you should need the regional implant representative (“Rep”) contact information.
Completing this form online provides secure, seamless, and timely delivery of your patient information directly to our office. After you have completed the form, please make sure to press the Submit button at the bottom.
If you have any questions regarding a patient referral, please call us at Houston Office Phone Number 713-439-7575.