Call (541) 776-7640 831 Alder Creek Dr, Medford, OR 97504
Referral Form Schedule a Visit
For Referring Dentists

Referring Doctors

A transparent, straightforward referral process — because your patients, and your trust, matter to us.

Download Referral FormCall to Refer a Patient

How to Refer a Patient

  1. Download our referral form.
  2. Fill in the patient and referring dentist, circle the teeth that may need treatment, and check the treatment requested.
  3. Email the form and radiographs to medfordrootcanal@gmail.com, or fax it to (541) 776-7630 or (541) 632-8290.

Urgent case? Call us directly at (541) 776-7640.

Report Turnaround

You’ll receive a treatment report the same day your patient is seen, so you always know what was done and what comes next.

What We Commit To

  • Clear, timely communication back to your office
  • Your patient returns to you for restorative care
  • Respect for the referring relationship you've built with your patient

Want to Talk Directly?

Call (541) 776-7640 to discuss a case or ask about our referral process.

Call (541) 776-7640