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Patient Referrals – Tucson, AZ


Select the Tooth or Area Needing Treatment:

tooth chart

Treatment Requested:

Anesthesia Preference:

General Information for all Patients

  1. Please call (520) 886-8090 to arrange your first appointment, if not appointed yet.
  2. If you are under 18 years of age, you must be accompanied by a parent or legal guardian of consent.
  3. If you have recent x-rays of a tooth/teeth to be treated, please email them from your dentist's office. An additional x-ray will usually need to be taken for comparison.
  4. Fees are payable at the time of treatment. Payment plans available.
  5. Please bring this form with you to your first appointment.
  6. To ensure that you receive the best care possible, your doctor will review your medical history with you. Please bring a list of the medicines that you are taking and any medical conditions you may have.

Your appointment time is reserved especially for you. If you are unable to keep this time, please give 48 hours notice to avoid a $50 cancellation fee.

For Patients Having Oral of IV Sedation

Patients who will be sedated for their surgery require a consult appointment prior to the surgery date.

Contact Us/Map

6375 E. Tanque Verde Rd. Ste. 30 Tucson, Arizona 85715
(520) 886-8090