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 20  we will be open Monday, Tuesday, Thursday and Friday.  We will be closed Memorial Day, May 27, and working Tuesday, Wednesday, Thursday, and Friday for the rest of that week.  For the month of June we will be working normal weeks, Monday, Tuesday, Thursday and Friday and closed Wednesdays.