Professional referrals to Kottemann Orthodontics

Facilitating seamless collaboration between healthcare professionals to ensure the highest standard of patient care. Refer your patients to our specialized dental practice with confidence.

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Expertise and specialization

Refer to us for dental care that requires specific expertise or specialized treatment. Our team of dental specialists is equipped with the knowledge and technology to handle complex cases, providing your patients with the best possible outcomes.

Comprehensive care approach

We offer a full range of dental services. Our approach ensures that your patients receive comprehensive care tailored to their unique needs.

Streamlined communication and follow-up

Our referral process is designed for ease and efficiency, ensuring open lines of communication between our team and referring doctors. We provide regular updates on your patient’s progress and collaborate closely to achieve optimal treatment results.

Professional Referrals Form

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Parent name*

First Last

Parent email*

Parent phone*

Patient name*

First Last

Patient DOB*

Insurance Information (ie. company, subscriber #)

Referring practice name*

Referring practice email*

Referring practice phone*

Referring doctor phone*

Date of referral

Date of most recent services

Digital x rays taken and emailed?*

Yes

No

Areas of concern*

Consultation

Decay

Sedation/ General Anesthetic

Age/ Behavior

Emergency Care

Comprehensive Care

Remarks

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