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 weeks of July 30, and August 6, 2018, we will be open Monday, Tuesday, Thursday and Friday, our regular schedule.  For the week of August 13, we will be open Monday, Tuesday, Wednesday, and Thursday, and CLOSED Friday, August 17th.  For the weeks of August 20 and 27, we will be open our regular schedule of Monday, Tuesday, Thursday, and Friday.