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 November 24th & 25th for Thanksgiving. We will also be closed December 21st-30th for Christmas, and January 30th and 31st. With those dates noted, the office will be open Monday, Tuesday, Thursday and Friday, regular hours to serve you.