Online 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 Submit 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.  Our fax number is 515-440-1184.

Note to General Dental Office:   On July 2, and 3, our office will be open.  Starting July 4th through Wednesday, July 11th, 2018, Dr. Erickson will be on vacation.  We will reopen July 12 to serve you.  For the week of July 16, we are open Monday through Thursday, and closed Friday, July 20, 2018.  For the weeks of July 23 and 30, we are open the regular schedule of Monday, Tuesday, Thursday and Friday to serve you.  Happy 4th of July!!!!