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 Thursday and Friday November 25th and 26th for Thanksgiving. We will also be closed Friday December 17th, 21st-24th, and the 31st for the holidays. With these dates noted, the office will be open Monday, Tuesday, Thursday and Friday to serve you.