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Please locate the service needed for your patient and use the appropriate means below to begin the referral process or to find out more about the services offered by the university of michigan school of dentistry. Doctor email * numbers, letters, hyphens, apostrophes (name@example.com) doctor street * numbers, letters, spaces, hyphens, apostrophes doctor city * numbers, letters, spaces, hyphens, apostrophes doctor state * only u.s If you are not referring on behalf of a dental provider, please ask your patient to have a dental provider submit a referral
If you are referring a patient with state insurance you must be a participating provider for medicaid/medicare (npi must be registered for state insurance). States are currently available doctor zip code * numbers, hyphen (format Is the patient being referred for advanced dental care to be provided by a dental specialist (root canal, biopsy, oral surgery), i.e
Not care performed by a general dentist?
For patients requiring wisdom teeth extraction, other extraction, implants, or treatment for exposure who do not have an underlying severe medical condition such as congenital heart disease, a bleeding disorder, or other severe underlying medical condition, please submit your referral to the school of dentistry's oral & maxillofacial surgery. At the bottom you can print and/or save this form, or go back to make changes, or submit the form The referral request will not be complete until it is submitted. These same questions will need to be answered again in the referral form
Periodontics if you are looking for an oral medicine referral, please fill out the comprehensive clinical pathology services form Doctor information doctor first name * letters, spaces, hyphens, apostrophes doctor last name * letters, spaces, hyphens, apostrophes Doctor city * numbers, letters, spaces, hyphens, apostrophes doctor state * only u.s
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