Issaquah, WA 98027
(425) 382-7465
Main Website
Main Website
Referrals to 425 Specialists
For 425 Patients Not Scheduled
Team Member Name
Name
Patient Name
(Required)
First
Last
Referral for:
(Required)
Select One
Oral Surgery
Periodontics
Prosthodontics
Endodontics
Time Sensitive?
(Required)
Yes
No
Referral completed and initialed by General Dentist in Dentrix?
(Required)
Yes
No
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
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