Online Referral Form
Secure Referral to Orange County Oral Surgeons & Dental Implant Center
You may refer patients to our office by filling out our secure online Referral forms. After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it.
Referral Form for Dental Implants, Jaw Surgery, and Oral Surgery
Referral Form for The Center for Oral & Facial Reconstruction & Ambulatory Care Services
After you submit your Referral, you will have the opportunity to securely upload and transmit images for the referral. For assistance, please call our Irvine office: Orange County Oral Surgeons & Dental Implant Office Phone Number 949-727-7000.