Referral Form

Thank you for choosing our practice! We are committed to becoming a valued part of your dental team providing you complete dental care. To help you in scheduling your visit please be aware of the following:

  1. The initial visit is to introduce ourselves and to comprehensively evaluate and discuss your situation. Please keep in mind this enables us to tailor your care to your specific needs and requirements.
  2. So as not to inconvience you all patients under 18 must be accompanied by a legal guardian at the time of the initial visit.
  3. To maximize your visit please have all pertinent medical information, xrays, medications, and insurance information available so we can better care for you. Current xrays (less than 1 year old) are necessary to evaluate your situation and determine your treatment. Please be aware additional xrays may be required to determine your best care.

Please use the following link to download a referral form. You may fax it to us at (252) 261-1335 or email it to This email address is being protected from spambots. You need JavaScript enabled to view it.

Referral Form

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