Referring a Patient for Evaluation and/or Treatment
We our happy to provide your office with referral pads to facilitate the referral of a patient. If your supply is low, or you are a new referral to our office, we have provided a link to allow you to print a referral slip to give to your patients. The “Referral Form” link below will open a PDF of our referral pad which you may print as you need them.
- Referral Form
Click here to send x-rays to Anchor Bay Oral Surgery, PC – HIPPA Compliant Portal
Referral for Cone Beam CT Scan ONLY
We are pleased to announce that we have added Dental Cone Beam Scanning technology at Anchor Bay Oral Surgery, PC. We are not providing services as a full fledge imaging center, but on the occasion where you feel your patient may benefit from a 3-dimensional dental x-ray we can assist in securing the view you desire. To assist in the referral for the CBCT Scan, we have provided you with a prescription form for you to complete.
The prescription format requires that the prescription must be completed to define the region of interest and must be signed by the referring provider. Anchor Bay Oral Surgery, PC will only be securing the scan and assessing it for quality and verification that the indicated region of interest is included in the scan. We will not be providing any interpretation or opinion on the scan. Please note, that unless specified otherwise by the referring provider, the scan will be sent for a formal reading by an Oral and Maxillofacial Radiologist. There is an additional cost to the patient for this service.
CBCT Referral and Consent (1 page)