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 regular hours the week of September 24, 2018, Monday, Tuesday, Thursday and Friday.  For the weeks of October 1, 8, 15, 22, and 29, we will also be open our regular schedule, Monday, Tuesday, Thursday and Friday, and closed Wednesday.