Refer a Patient

A successful practice doesn’t just happen; it is the result of a strong commitment to excellence in the professional community and in the relationships we build with our patients and colleagues. We appreciate the confidence you’ve placed in us to provide you with the complete care you need, and we thank you for recommending our practice to your friends and family.

If you are here to refer a patient to our practice, please provide us with the information either through this printable form, or the online form below.

Practice Information

Referring Office/Doctor Name:

Referring Office Phone Number:

Date of Referral:

Referral Information

Patient's Name:

Parent's/Guardian's Name:

Patient's Phone Number:

Patient's Dental Insurance:

Treatment Recommended:

Was Treatment Attempted at your office?

Yes No

In your opinion, will this patient need?

Radiographs Sent?

Yes No

If this form is not completely filled out we won’t be able to approve your appointment request.

Parents & Children Love Our Practice!

"I have been taking my children to Great Beginnings for years now. Dr. Laura and her staff are absolutely wonderful. They make you feel so comfortable and like you belong there. It’s like one big family. Every child is treated so special."

"If I could give this office ten stars, I would. The staff is so sweet and amazing down to even the lady who works in finance. They are all so patient and nice. My daughter went in for her lip tie and they were so thorough and respectful and let me know the decisions were all mine. "

"Dr. Laura and her staff are amazing! They make the children feel comfortable, and her new office is just beyond amazing! Have never left her office disgruntled or upset! I recommend this office to anyone that asks about a pediatric dentist because she is just that good!"

"We LOVE Great Beginnings! My daughter is 3 and she loves the video games in the waiting room, the TVs on the ceiling to watch from the dentist chair, and the prize she gets out of the machine at the end. The facility is INCREDIBLE. It is beautiful and so clean."

"Absolutely amazing dental services for children here. The office is clean and very kid friendly. Lots of bright colors, decorations and children's games. I can't thank the office enough for how well you treated my daughter on her first visit. "

"Wonderful experience every time! My 5 and 3 year old had visits recently and the staff could not have been nicer! My 5 year old is very anxious going to the dentist and they really eased his mind by telling him everything they were going to do before they did it."

"This was my granddaughter Marla’s first dental visit since my receiving custody of her. When I saw that the office was child friendly, I could see Marla relax. She started playing a game in the gaming room. The staff was friendly, efficient and accommodating."

Refer a Patient

Parents & Children Love Our Practice!

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