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Referral Form

If you wish to refer patients to our practice; please send a completed Referral Form and email to

We would be happy to help with any patients from 1-12 years old. Please include Parents contact information and detailed reasons for referral so that we can reach out to them.
Please give us a call at (503) 305-6505 if you need information regarding in-network Insurances or if you have any questions regarding our services.
Please let your patients know that it is customary for us to complete a consult exam before treatment and to take any additional radiographs if we determine them to be necessary.