Referral Form

Thank you for trusting our team with your patients’ care.

Below we have a downloadable referral form by location for your convenience—please click below to access them. You can email them to [email protected]

Peterborough: Click here!

Gilford: Click here!

Concord: Click here!

If your patient’s dental insurance requires a specific referral form, please ensure your office completes it fully.

For most emergency cases, we strive to see your patients the same day. If your patient has any medical conditions that require special consideration, we kindly ask that you contact us directly to discuss the case.