How to Refer

We appreciate your continued confidence in working with our office. To ensure the best comprehensive care for our mutual patients, please send periodontal charting and restorative treatment plan by fax or via mail.

Contact Information

Confidentiality Note: This document contains information which is confidential and/or privileged. The information is intended only for the use of Implant Dentistry and Periodontics. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or the taking of any action in reliance on the contents of this document is strictly prohibited, and that these documents should be forwarded immediately to Implant Dentistry and Periodontics. If you have received this document in error, please call (866) 275-2515.

Print this Form

Instead of submitting online, you can download and print this Referral Form (PDF). Just visit our office or fax your completed form.

Placing Our Electronic Referral Slip on Your Desktop

  • Step 1: Go to www.indyimplants.com
  • Step 2: Right click on the tan area under the blue section and select "create shortcut"
  • Step 3: Answer yes to "Do you want to put a shortcut to this website on your desktop?"
  • Step 4: Close out of the website. It should now be on your desktop.