Referring Provider | Plateau Dentistry for Children

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Thank you for your referral. Please Submit a referral by:

- Clicking the button below and submit it online.

ONLINE SUBMISSION of referral form

OR

- Print the referral form below to be emailed or faxed to our office.

Referral Form to Print (PDF)

LAST STEP: Don't forget to email us any radiographs by clicking the email address below

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