Home
Our Practice
Our Services
Patient referral
Patient Info
Contact
Our Practice
The Team
Clinic
Oral Surgery
Our Services
Dental Implants
Bone Grafting
Pathology
Dental extraction
Orthodontic anchorage (mini-implant)
Surgical exposure of impacted teeth
Pre-prosthetic surgery
Wisdom Teeth Removal
Intra-venous sedation
Endodontics
Root Canal therapy
Endodontic re-treatment
Apicoectomy
Patient referral
Endodontics
Oral surgery
Patient Info
Patient Information
Financial Options
518-561-0301
Home
Our Practice
The Team
Clinic
Our Services
Oral Surgery
Dental Implants
Bone Grafting
Pathology
Dental extraction
Orthodontic anchorage (mini-implant)
Surgical exposure of impacted teeth
Pre-prosthetic surgery
Wisdom Teeth Removal
Intra-venous sedation
Endodontics
Root Canal therapy
Endodontic re-treatment
Apicoectomy
Patient referral
Endodontics
Oral surgery
Patient Info
Patient Information
Financial Options
Contact
Home
/ Patient referral / Oral surgery
Oral surgery
Patient Name
*
Parent or Guardian
*
Patient Phone
*
Patient Email
*
X-rays:
Emailed
Sent with patient
Please take x-rays
Please check all that apply:
*
Dental Extractions
Alveoloplasty
Frenectomy
Implant Consult
Orthognathic Surgery
Soft Tissue Surgery
Orthodontic Exposure
re-Prosthetic Surgery
Pathology/Lesion
Other
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
32
31
30
29
28
27
26
25
24
23
22
21
20
19
18
17
a
b
c
d
e
f
g
h
i
j
t
s
r
q
p
o
n
m
l
k
Comments
Reffering Doctor:
*
Phone
*
*
Required fields
Submit
New patients welcome!
Book now