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 with our regular schedule for all weeks of June  1, 8, 15, 29.  We are working on our On line referral and it will be up and running shortly.