Referral Forms

The following forms can be used for a variety of referral needs. Please follow the specific directions listed within each referral form for how to submit the information. 

Do NOT submit referrals to the webmaster.

Follow the referral form's specific directions for how to submit referrals. For questions, please contact the clinic directly. 

Referral Required

Advanced Prosthodontics and Implant Clinic

Geriatric Oncology Dental Clinic

Graduate Endodontic Clinic (Root canals)

Graduate Periodontology Clinic

Oral and Maxillofacial Imaging

Oral and Maxillofacial Surgery Clinic

Please note

We have changed our referral process. Our process is now an online submission for your referral to Oral and Maxillofacial Surgery.

Once the referral is submitted, email imaging to Imaging must include the patient’s full name, date of birth, and date of imaging. Please discontinue using our previous referral form. We will not accept faxed referrals. The referring physician will be notified directly (preferred email address) for any referral we cannot accept. Our office staff will contact your patient if the referral is accepted.

Ohio State Dental Faculty Practice 

Ohio State Upper Arlington Dentistry (off-campus)

No Referral Required

General Practice Residency Clinic

Orthodontics Clinic

Pediatric Dentistry Clinic

If you require assistance with these forms, please contact our webmaster