Referral Form for Our Referring Partners

We’re pleased to provide an online referral form designed to streamline the referral process and make submissions more convenient for our referring partners. Please complete the form below to refer a patient.

"*" indicates required fields

This field is for validation purposes and should be left unchanged.
Return Patient*
MM slash DD slash YYYY
Treatment Type*

We’re pleased to provide an online referral form designed to streamline the referral process and make submissions more convenient for our referring partners. Please complete the form below to refer a patient.

Image
Treatment Type*
Treatment Type*
Treatment Type*
Treatment Type*
Treatment Type*

Experience contactless check-in in Tacoma, WA

To ensure a quick and straightforward dental emergency visit, we'll collect your forms, insurance information, and payment methods digitally.

Online Booking

We keep our wait times low for your convenience and safety

We know you have a million things to do, so we respect your valuable time. We'll be ready and waiting for you!

Online Booking

Let Us Help With
Your Pediatric Dental
Emergency!

We don't just solve problems,
we prevent them.
Book Now

In case of a pediatric dental emergency, call:

(253) 848-7000

Safety is our priority

Enhanced PPE, squeaky clean offices, and sterilized equipment.

Gentle Cleaning

We are thorough, but also make sure our patients are comfortable.

Only what's necessary

We make suggestions based on what your child needs. Nothing extra.
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