Referral Form

We are proud to be trusted with each patient referred to us for treatment and are committed to providing them with safe, high-quality care.

Please complete the form below. Once you press Submit, it will be emailed directly to our team.

If you prefer to handwrite the referral, you can download our form Click here and print. You would then fax or e-mail the completed referral to referrals@dentasc.com or fax 559-263-9777

Don’t forget to attach if available patients treatment plan and any x-rays.
Thank you for your referral!

If you prefer to fill out the referral form via PDF click here. Once completed, please print and fax or email the form to us.
Fax: 559-263-9777 Email: Referrals@dentalasc.com

Referral Form

Refer a Patient

To submit a referral

Upload Referral Forms

Referral Form

Refer a Patient

To submit a referral

Upload Referral Forms

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