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Referring Doctors Form

Thank You For Your Referral

A successful practice doesn’t just happen; it is the result of a strong commitment to excellence in the professional community and in the relationships we build with our patients and colleagues. We appreciate the confidence you’ve placed in us to provide you with the complete care you need, and we thank you for recommending our practice to your friends and family.

 

If you are here to refer a friend to our practice, please provide us with the information below. Once you’ve completed the form, click on the SUBMIT button at the bottom of the page.

Practice Information

Referral Information

Name of the Patient You are Referring(Required)
Parent Name (if patient is a child)

San Dimas Location

Office Hours

Orthodontic Services Only

Monday & Tuesday: 9:00am – 6:00pm
Closed: 12:30pm – 2:00pm (For Lunch)

Oral Surgery Services Only

Wednesday, Fridays, Saturdays
By appointment only, hours and days may vary

Diamond Bar Location

Office Hours

Orthodontic Services Only

Thursday & Friday: 8:00am – 5:00pm
Closed 12:00pm – 1:30pm (for Lunch)
Saturday: 8:00am – 2:00pm (Alternating Saturday)

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