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Referral for Doctors

Exceptional care is built through dedication, trust, and lasting relationships with both our patients and referring providers. At Seattle Periodontics & Implant, we are committed to delivering the highest standard of periodontal and implant care while creating a welcoming and collaborative experience for every patient we serve.

We are honored by the confidence our patients and referring doctors place in our team, and we sincerely appreciate your continued trust and recommendations to friends, family, and colleagues. Our referral network proudly extends throughout Washington State, with partnerships spanning Seattle, Bellevue, Redmond, Kirkland, Bothell, Everett, Tacoma, Spokane, and surrounding communities, as well as neighboring states throughout the Pacific Northwest.

To refer a patient to our practice, please complete the referral form above and click “Submit Referral” once finished. You may also choose to save or print a copy for your records before submitting. Prefer a handwritten form? A printable referral form is also available for download.

Image by Jeremy Mowery

Referring Doctor Information

Patient Information

Birthday
Month
Day
Year
Subscriber is:
Preferred Contact Method
Doctor Preference

Patient being referred for?

Periodontal Examination
Implants
Perio-Ortho:
Gingival Grafts

Digital Radiographs & Pictures

  • FMX is requested for a Periodontal Evaluation

  • BWX or PA is requested for an Implant, Crown Lengthening or Graft Evaluation

  • Perio Chart is preferable if available

Please Select Which Xray Format you emailed to us (FMX PREFERRED):
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