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:    We will be open the weeks of January 14, and 21 our regular days of Monday, Tuesday, Thursday, Friday,  2019, to serve you.   For the week of January 28th, we will be closed Monday and Tuesday, the 28th and 29th, and will be open Wednesday, Thursday and Friday.   For the week of February 4, we will be open our regular days of Monday, Tuesday, Thursday,  and Friday.