Patient referral Please enable JavaScript in your browser to complete this form.Which location are you interested in referring your patient to? *Choose a location...Pittsburgh office - 4139 Brownsville Road, Pittsburgh, PA 15227Sewickley office - 2593 Wexford Bayne Road, Sewickley, PA 15143Referring doctor's name *Patient's name *Patient's phone *Tooth # or affected areaInstructionsIf you need to send x-rays, please send them to EMAIL ADDRESS HERE and include with the patient's name.EmailSubmit
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