Online Patient Referral Form

Route 66 Dental Implants & Periodontics Online Patient Referral Form

You may refer patients to our office by filling out our secure online Referral Form. After you have completed the form, please make sure to press the Complete and Send button at the bottom to automatically send us your information. The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it.

ONLINE REFERRAL FORM

At Route 66 Dental Implants, we value our relationships with referring dental practices and are proud to partner with you in providing excellent oral healthcare to our community.

To achieve a high level of trust with our shared patients, we:

• Review cases thoroughly in advance
• Collaborate with you on treatment plans
• Are available in an advisory role if requested
• Provide timely assessments and imaging

Thank you for your referral to our office.  If you have any questions about our practice, please call us at  918-749-1850.

Office Hours

Monday through Thursday:   8:30 AM – 4:30 PM