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:   For the week of May  21,  we will be open the regular schedule of Monday, Tuesday, Thursday and Friday to serve you.   For the week of May 28, we will be closed for Memorial Day, and reopen Tuesday, CLOSED Wednesday, and open Thursday and Friday to serve you.  For the Month of June and weeks 4, 11, 18, and 25, we will be open the regular schedule of Monday, Tuesday, Thursday and Friday.