You may refer patients to our office by filling out our Referral Form. To complete the form, please download it using the link below then proceed with adding the Referring Patient’s information. Once the form is complete, save your answers and email the document to email@example.com.
Please be aware that this is not a secure email network under HIPAA guidelines. Do not submit any personal or private information unless you are authorized and have voluntarily consented to do so. We are not liable for any HIPAA violations. Understand that if you email us, you are agreeing to the use of an unsecured method and understand that all replies will be sent in the same fashion, which you are hereby authorizing.
By checking this box you hereby agree to hold “Ridge Oral Surgery”, including it’s doctors and affiliates, harmless from any hacking or any other unauthorized use of your personal information by outside parties. By checking this box, you also agree to receive email communication from “Ridge Oral Surgery”, including its doctors and affiliates.