Issaquah, WA 98027
(425) 382-7465
Main Website
Main Website
Referral to 425 Dental
Child's Name
(Required)
First
Last
Name of Responsible Party
(Required)
First
Last
Time Sensitive?
(Required)
Yes
No
DOB for child
MM slash DD slash YYYY
Reason for referral (?)
(Required)
Select one
Oral Surgery
Periodontics
Prosthodontics
Endodontics
General Care
Invisalign
Notes
Let patient know that TIME SENSITIVE referrals will be followed up no later than 1 business day and non-TIME SENSITIVE no later than 4 business days
