Online Oral Surgery Referral Form

Please note: At this time, Richardson Oral and Facial Surgery remains available to those who need urgent or emergent care in the North Dallas area during the COVID-19 pandemic. For assistance, please call our Richardson office at Richardson Oral and Facial Surgery Phone Number 972-231-6661.

You may refer patients to our office by filling out our secure, online Referral Form.

When you have completed the form, please make sure to press the Complete and Send button at the bottom to automatically send us your information. After you submit the referral you will have the opportunity to securely upload and transmit images related to the referral.

Online Referral Form

The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it.