Please CLICK HERE to submit a new referral or manage new patient cases with our new Collaborator 2.0 software.
This website will allow you to refer patients to our office and collaborate on case development. Due to stringent HIPAA requirements, you must have an individual user name and password to access this portion of our website. For first time users or if you have forgotten your password, please e-mail us at: [email protected].
Doctor 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 Submit 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.
Technical Note: *Once reviewed, scroll down to submit your referral!
Our online form uses the latest version of Adobe Acrobat Reader to conveniently submit the form from home or work. Please download the free plug-in from Adobe’s web site if it is not already installed on your system. It is important that you have at least version 9 of the plug-in to successfully use our online form.