WOODINVILLE: 425.402.1246

BOTHELL: 877.402.1246


OFFICE HOURS:

TUES - THURS 8AM -5PM

FRIDAY 7AM - 2PM

Referring Doctor

DR. LABELL AND HIS STAFF WOULD LIKE TO THANK YOU FOR RECOMMENDING US TO YOUR PATIENTS.

We work hard to not only provide the periodontal care you expect, but also to compliment the treatment you are providing for your referred patients in your office. By taking the time to give us as much information as possible, we can insure that we are fully prepared to meet your patient and undertake the periodontal care you are requesting. To help with this process, please fill out as much of the information below as possible. We may also be in touch with your office to request any records that can help us provide the periodontal care you are requesting.

We find that the highest follow-through of referred patients occurs when patients are scheduled directly from your office. It also helps get accurate information and records transferred quickly so we can help meet the periodontal needs of your patient as quickly as possible. If you call while the patient is in your office, we will make every effort to get them scheduled as quickly as possible.

We are happy to supplement any radiographs that are required to evaluate your patient's periodontal concern, but if you have current radiographs (with the last year) we would like to have them available. We recommend an FMX for comprehensive cases, a periapical radiogiograph for specific areas (except grafting) and either a panorex or PA of possible implant sites.

Please advise your patients that they will be seen first for a separate evaluation appointment so we can evaluate the concern, discuss treatment options and explain the chosen treatment procedure.

Referring Doctor Information
Referring Doctor's Name *
Referring Doctor's Name
Doctor's Phone *
Doctor's Phone
Patient Information
Patient Name *
Patient Name
Address
Address
Phone *
Phone
New patient to your office? *
Purpose of Referral
Services Needed:
Records Available
Last Dental Cleaning
Has SRP ever been completed in your office?