Online Referral Form

We value the trusted partnerships we share with local referring offices. To make the referral process as seamless as possible, we’ve created a secure online referral form specifically for you. 

The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it. The online referral form ensures fast, compliant, and efficient communication. After you have completed the form, please make sure to press the Complete and Send button at the bottom to automatically send us the requested information. 

Thank you for choosing Griffitts Facial & Oral Surgery—we look forward to coordinating your patients’ care with you! 

Online Referral Form