Online Referral Form

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. If you can not use the ONLINE referral form, just simply email us with patient name, desired treatment/ evaluation contact number or pertinent information concerning the referral. Referrals can be emailed to info@cordovaoralsurgery.com