Referral Form for Doctors
Thank you for trusting District Dental Surgery with your patients’ periodontal and implant care. To make the referral process simple and efficient, we’ve provided our referral form below for you to download, print, and fax or email back to us.
How to Refer a Patient:
- Download & Complete the Form: Please include any relevant X-rays, treatment notes, or additional documentation.
Send the Form to Us in One of the Following Ways:
Email:
- Washington, DC office: DC@DDSurgery.com
- Bethesda, MD office: MD@DDSurgery.com
Fax:
- Washington, DC office: 202-293-1914
- Bethesda, MD office: 301-493-6276
With the Patient:
You may also give the completed form to your patient to bring to their first visit.
Questions?
We’re here to support your team and ensure your patients receive exceptional periodontal care. Please don’t hesitate to reach out!
- Washington, DC office: 202-393-6154
- Bethesda, MD office: 301-493-6200
