Refer a Friend

A successful practice doesn’t just happen. It is the result of a strong commitment to excellence in our treatment and in our relationships with patients and doctors. We’d like to take a moment to thank you for showing your confidence in our practice by recommending us to your friends, family, and colleagues. We’re gratified to find how many new patients regularly call on us based on your words of advice.

Some people say that their orthodontic experience with us has literally changed their lives. Others have described increased self esteem, including a sense of power, passion, and grace. Whatever your feeling, if you are happy with your experience with our office, may we suggest two ways for you to tangibly show your appreciation.

Patient Referral Form

If you are a patient of record who has referred a new patient to us, please let us know by filling out and submitting the following form.

    • Today's Date:

    • Your Name:

    • Your Phone Number:

    • Your Email Address:

    • Full Name of the Patient You Are Referring:

    • Comments: