Doctor Referral

Dental and medical professionals who would like to refer a patient to PDG should fill out the attached referral form. We will contact you when we have received the patient’s information and will provide you with status updates on the patient’s care.

2.4.1#2     computer scanning impression of teeth

Referring Doctor (required)

Patient Name (required)

Patient Phone Number

Requested Doctor (required)

Reason for Referral (required)