referral forms

Referral Form

Thank you for your referral!

We appreciate the trust you place in us when referring your patients. Please fill out the encrypted form below to start a patient referral, request a second opinion, or schedule a consultation with our practice. Our commitment is to treat your patients with the utmost care and compassion.


Request an Appointment

We are proudly accepting Medicaid and welcoming new patients from Lancaster and surrounding areas. Our team offers a comprehensive range of dental services, including routine cleanings and check-ups, fillings, root canals, crowns, and more—providing high-quality, accessible care for the whole family.

Our Location

Conveniently Located in Lancaster

Lancaster

(740) 908-4842

784 E Main St
Lancaster OH 43130

Hours:
Monday: 8:00 am - 5:00 pm
Wednesday: 8:00 am - 5:00 pm

Associations and Memberships

We’re proud to be affiliated with the following organizations:

ADA Black
ODA Grayscale
Alpha Omega International Dental Society

5-Star Patient Reviews