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 Complete and Send 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.

Online Referral Form

Our fax number is 515-440-1184.

Note to General Dental OfficesWe will be closed on Monday July 5th, as well as Thursday July 15th and Friday July 16th. With these dates noted, the office will be open each week in July and August Monday, Tuesday, Thursday and Friday to serve you.