Online Oral Surgery Referral Form
The Center for Oral Surgery & Dental Implants welcomes referrals from colleagues. We strive to provide an exceptional oral surgery/implant experience by supporting our patients and their referring doctors. At the appropriate stage of treatment, patients will be returned to their referring dentist.
We are available for consultation or treatment for any of the following:
- Planning and assessment
- Bone and soft tissue grafting
- Impression procedures
- Prosthetic try-in/fitting of prosthesis
- Bone expansion procedures
- Single tooth spaces potentially requiring implants
- Multiple toothless spaces/complex restorative needs
- Where one or both arches are edentulous or near edentulous
- Full or partial dentures requiring implant stabilization
- Difficult implant cases: for example, due to anatomical structures or insufficient bony volume
- Aesthetic rehabilitation &and complex aesthetic cases
We invite you to speak to any of our doctors to discuss the needs of your patient. Informal inquiries are welcome.
You may refer patients to our office by filling out our secure online Referral Form. After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it.
Or you can downloading our referral form and fax it to 616-361-9882.
You can email any necessary patient x-rays as an attachment to: [email protected]
Referral Doctors Please Read our X-Ray policy below effective August 1, 2018
The recent expansion in dental digital imaging has improved patient care by providing excellent diagnostic quality images with lower radiation exposure. Unfortunately, portability of these images is becoming an issue. The transmission of these images to our office is not as simple as mailing a film image. Film images were simple to keep identified because they had patient identifier information on the film.
Today’s images have no visible patient identifier on the actual image and a cryptic numerical file name attached. This creates problems regarding patient safety, efficiency of care and, in some cases, cyber security for our office. We are all very concerned with wrong or missing patient name, date of birth or date image taken, with your office and ours using digital imaging. Submission of digital media via flash drives has been discouraged by our cybersecurity consultants.
Effective August 1st, we are asking you to send your diagnostic images, with the patient name, date of birth, date of x ray and L and R orientation somewhere directly on the image, perhaps by converting it to a PDF. All software and digital systems are different and you know how to best send identifiable digital x-rays.
If you have a CBCT image set suitable for our use, we would be happy to use a gallery of images submitted via PDF with patient name, date of birth and date of x ray on the document. We will not accept CBCT raw image files from other offices for diagnostic purposes. With multiple brands of CBCT machines on the market, each with their own proprietary reader software, it is often impossible for us to of retrieve the images necessary for care. We will also review diagnostic images performed outside out office for patient we see in our office. There are Oral and Maxillofacial Radiologists available to provide complete readings of CBCT images as well as plain films for patients you are not referring to us as patients. If you would like to know who we use, please ask.
Thank you for your consideration of this matter as we all continue to work together to provide the best care for patients.
Center for Oral Surgery & Dental Implants
Dr. Richard Panek Dr. Emily Van Heukelom Dr. Roseanna Noordhoek Dr. Julie Billips