Update Your Preferences

What are your preferences on referrals for the following procedures?

Doctor's Name:

First Name
Last Name

Extractions

Primary teeth

Back to me (I do these procedures)
To a specialist of your choice (I don't have a strong referral preference)
To one of the specialists listed below:

Permanent teeth, erupted

Back to me (I do these procedures)
To a specialist of your choice (I don't have a strong referral preference)
To one of the specialists listed below:

Permanent teeth, unerupted

Back to me (I do these procedures)
To a specialist of your choice (I don't have a strong referral preference)
To one of the specialists listed below:

Other Procedures

Perio: Long-term periodontic management

Back to me (I do these procedures)
To a specialist of your choice (I don't have a strong referral preference)
To one of the specialists listed below:

Perio: Single appointment periodontal procedures (grafting, frenectomies, fibrotomies, esthetic crown lengthening)

Back to me (I do these procedures)
To a specialist of your choice (I don't have a strong referral preference)
To one of the specialists listed below:

TMD: Chronic pain management

Back to me (I do these procedures)
To a specialist of your choice (I don't have a strong referral preference)
To one of the specialists listed below:

TMD: Joint derangement

Back to me (I do these procedures)
To a specialist of your choice (I don't have a strong referral preference)
To one of the specialists listed below:

TMD: Splints for bruxism

Back to me (I do these procedures)
To a specialist of your choice (I don't have a strong referral preference)
To one of the specialists listed below:

Endo: Simple single-rooted teeth

Back to me (I do these procedures)
To a specialist of your choice (I don't have a strong referral preference)
To one of the specialists listed below:

Endo: Complex, multi-rooted molar teeth

Back to me (I do these procedures)
To a specialist of your choice (I don't have a strong referral preference)
To one of the specialists listed below:

OTHER: (please specify)

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