Partner with Prosper Periodontics and Dental Implants for Exceptional Patient Care

At Prosper Periodontics and Dental Implants, we value the trust you place in us when referring your patients. Our team is dedicated to providing top-quality periodontal and dental implant care while ensuring your patients feel comfortable and well cared for. We maintain open communication with you throughout the treatment process, so you can stay informed every step of the way.

Refer your patients today by downloading our referral form or filling out the online form below to experience the Prosper Periodontics difference.

    Referral Form

    DATE:

    PLEASE CALL MY PATIENT TO SCHEDULE AN APPOINTMENT

    MY PATIENT WILL BE CALLING YOU TO SCHEDULE AN APPOINTMENT

    MY PATIENT REQUIRES A COMPLETE EXAMINATION FOR (PLEASE SPECIFIY SITE):

    PERIODONTAL EVALUATION

    BONE GRAFT

    EMERGENCY

    IMPLANT EVALUATION

    PERI-IMPLANTITIS (LAPIP)

    EXPOSURE OF IMPACTED TOOTH

    EXTRACTION

    ORAL PATHOLOGY / BIOPSY

    3-D CT Scan

    SRP/PERIOSCOPY

    COSMETICS

    CROWN LENGTHENING

    WISDOM TEETH EXTRACTION

    LANAP

    OTHER

    GUIDED TISSUE REGENERATION (GTR)

    SOFT TISSUE GRAFT/RECESSION TREATMENT

    YES

    BEING SENT

    PATIENT BRINGING

    WOULD LIKE US TO TAKE

    DATE TAKEN:

    ANTIBIOTIC PROPHYLAXIS:

    YES

    NO

    PLEASE CALL ME:

    BEFORE CONSULTATION

    AFTER CONSULTATION