Referral Forms

Your dentist or physician must provide you with a referral form indicating the requested treatment or procedures. This is a legal document and important part of the communication between our office and your doctor. The referral form may be provided in three ways:

Online referral form from your dentist / physician


Fax referral form to (301) 654-7050


Paper referral form



  • If you were given a written referral from your dentist or physician, please bring with you to your appointment.