Return Home

Periodontal Referral


Referring Doctor

Refer To


Patient Information

Appointment Information


Patient will call to schedule appointment.
Please call patient to schedule appointment.

Patient will need an interpreter.

Patient has special needs.

Periodontitis
Implants
Extractions or Surgical Exposures
Ridge Preservation/Augmentation
Soft Tissue Grafting
Other


A

B

C

D

E

F

G

H

I

J

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

32

31

30

29

28

27

26

25

24

23

22

21

20

19

18

17

T

S

R

Q

P

O

N

M

L

K

Comments

Attachments

Maximum size for attachment: 15MB

Images

If you would like to include images for our staff to review please click the choose file button and select the image file. Then enter the date the image was taken. Finally click the blue 'Add' button. If your image was sucessfully added it will appear in the table below.



Image Name Date Taken
None added

Documents

If you would like include a document for our staff to review please click the choose file button and select the apporiate document. If you would like to upload multiple items, please follow the process to compress the items into one '.zip' file. Then click the choose file button and select the '.zip' file.


University of Minnesota Dental Clinics
515 Delaware Street SE, 16-205 Moos Tower
Minneapolis, MN 55416
P: (612) 625-2495
F: (612) 624-2669