Patient Referral
Submit a Referral
Send patient information, referral details, and tooth or treatment area.
Prefer a paper referral?Download our PDF referral form here.
Submit Referral OnlineFor Referring Doctors
Refer a patient
Submit referrals and supporting records securely to Roosevelt Oral Surgery.
For Referring Offices
Choose how you'd like to send the referral.
Referrals and records are submitted through our secure Microsoft 365 referral system. For urgent clinical concerns, please call our office.
Referral Process
What happens after you refer a patient
01
Submit the referral
Send the patient's referral information through our secure online form, or download and fax/email the PDF referral form.
02
Send available records
Upload relevant radiographs, imaging, or supporting clinical records through our secure portal.
03
We contact the patient
Our team will coordinate with the patient regarding consultation and scheduling.
04
We coordinate with your office
We will provide appropriate updates and coordinate ongoing care with your treatment team.
REFERRING OFFICES
We're here to help
If you need help with a referral or records transfer, please contact our office.
For urgent clinical concerns, please call us directly.
Roosevelt Oral Surgery
Thank you for trusting us with your patients.
We value collaborative care and clear communication with our referring doctors and their teams.
Submit a Referral