referring offices

For almost twenty years, we’ve been welcoming patients referred by colleagues, physicians and other specialists from all areas of Oregon and beyond.

We strive not just to provide those patients with the best care possible, but to support our colleagues while establishing strong relationships with them. Our support isn’t limited to seeing the referred patient, we also provide prosthodontic education to our referral doctors and staff upon request. Likewise, we provide phone and in-person consultations.

If you have questions regarding a potential referral, feel free to call Alberto to discuss the case at 503-643-6607. If you are ready to refer a patient, simply complete this form and either fax it or email it to us at admin@ajadental.com.

If possible, to provide a smoother transition for your patients, always include with your referral the following records, if available:

• Full set of periodical films and/or bitewings

• Panoramic film

• CT scan

• Dental Insurance plan details if any

• Medical insurance details if applicable
  

(*) If you are an insurance company (Kaiser, Willamette, Providence), please include details of the plan as well as the coverage available for the first appointment.

(**) If you are a physician referring a patient for maxillofacial prosthodontic services, please include the medical diagnostic codes if available, as well as radiation therapy field related to maxilla and mandible, and total dosis of radiation per side.

(***) If you are referring a patient for sleep apnea, please include a copy of the most recent sleep study if available.

Please note that we are not Medicare providers.