Online Referral Form
Welcome Referring Dentists
To our referring dentists, we want to extend our warmest thanks.
At VALLEY ENDODONTICS in Harrisonburg VA, we value our relationships with referring dental practices and are proud to partner with you in providing excellent oral healthcare to our community. Your choice to put the care of your patients in our hands is the highest compliment our practice could receive. We have found that patients appreciate dental offices that partner with trusted specialists for complex procedures – it helps to build trust and loyalty in both practices.
To achieve a high level of trust with our shared patients, we:
- Review cases thoroughly in advance
- Refer back to your office for restorations
- Collaborate with you on treatment plans
- Are available in an advisory role if requested
- Offer accommodating scheduling
- Provide timely assessments and imaging
We have a selection of tools and resources assembled here such as a referral form and links to articles you may find interesting. If you have any questions about our practice, please feel free to call us at Harrisonburg Office Phone Number (540) 433-3636. Above all, we want to thank you for your referral of our office.
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.
Technical Note: *Once reviewed, scroll down to submit your referral!
Our online form uses the latest version of Adobe Acrobat Reader to conveniently submit the form from home or work. Please download the free plug-in from Adobe’s web site if it is not already installed on your system. It is important that you have at least version 9 of the plug-in to successfully use our online form.