Thank you for Choosing Micro Endodontics
Forms & Useful Info
When you refer your patients to Micro Endodontics, we ensure their needs are addressed rapidly and they receive the highest standard of care. We will also share information along the way so that you and your associates remain informed and involved. Micro Endodontics believes effective collaboration affords our patients the best opportunity for maintaining optimal oral health for life.
You will find our Referral Form below, along with our New Patient Registration and Medical History Forms. While the Referral Form is all we need to initiate care with your patient, sometimes it is helpful to save some time and provide everything as a single package.
Our standard referral form is a PDF file and can be printed and filled out with your patient’s basic information, treatment needed and any other notes or case specific requests.
HIPAA Compliance Statement
The Health Insurance Portability and Accountability Act of 1996, commonly referred to as HIPAA, required the US Department of Health & Human Services (Read More) to develop regulations protecting the privacy and security of certain health information. Micro Endodontics considers our patient’s health, personal and financial information to be of the utmost importance. We are a HIPAA Compliant practice and maintain all recommended provisions in protecting our patients privacy and data.
Questions or Concerns?
In the event you have any questions or if you would like to speak to one of our Endodontists, please feel free to call one of our Practice locations: