Online 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.

You may wish to advise patient of costs for consultations and CT scans. 

Generally

  • ACC consultations and CT scans – no charge to patient, they must have an ACC claim number.
  • Consultations $140 (add $150 if CBCT taken = $290 for consult and CBCT)
  • Just Cone beam CT with report, no consultation $285
  • Consultation and biopsy $450

  • If the patient has medical health insurance then all costs are generally covered – even if they don’t have a dental plan. These consults and scans fall under their medical or surgical policy.