Refer a Patient: Student Clinic

As of June 5, 2020, we are accepting referrals for ENDODONTIC and PERIODONTAL treatment ONLY as we slowly resume providing comprehensive patient care.


To Refer or Submit Radiographs: Download and complete the Patient Information Form. Save the completed form where you can easily access it, like on your desktop. Upload the completed form and radiographs below.

STEP 1: Submit the completed Patient Information Form below. In the Description Box, put the Patient's Name.

STEP 2: Submit images and radiographs below. In the Description Box, put the Patient's Name.