Meet Us
Meet Our Dentists
Meet Our Team
Our Blog
Tour Our Office
For Referring Doctors
Video Library
Membership Plan
Your Child’s First Visit
What To Expect
Frequently Asked Questions
Services
Athletic Mouth Guards
Daily Brushing & Flossing
Dental Sealants
Evaluating Growth & Development
EZ-Pedo Kid’s Zirconia Crowns
Fluoride Treatments
Guidance of Erupting Teeth
Oral Health Education
Preventing Baby Bottle Tooth Decay
Proper Nutrition & Dietary Habits
Regular Dental Visits
Sedation Dentistry
Special Needs Dentist
Contact
Request Appointment
Call us toll free
0800 1800 900
Find us on Map
pm@infogenix.com
Login
Remember me?
Login
(614) 475-5439
Schedule Online
Meet Us
Meet Our Dentists
Meet Our Team
Our Blog
Tour Our Office
For Referring Doctors
Video Library
Membership Plan
Your Child’s First Visit
What To Expect
Frequently Asked Questions
Services
Athletic Mouth Guards
Daily Brushing & Flossing
Dental Sealants
Evaluating Growth & Development
EZ-Pedo Kid’s Zirconia Crowns
Fluoride Treatments
Guidance of Erupting Teeth
Oral Health Education
Preventing Baby Bottle Tooth Decay
Proper Nutrition & Dietary Habits
Regular Dental Visits
Sedation Dentistry
Special Needs Dentist
Contact
Request Appointment
Referring Doctors
For Referring Doctors
Do Not include HIPAA protected medical information in this referral form
Doctors Office:
Parent's Name:
Patient's Name:
Treatment:
Under GA
In Office
Doctor's Email Address
*
Parent's Phone:
Comments:
*
I verify that there is no HIPAA protected medical information included in this referral form.
CAPTCHA
Please ensure Javascript is enabled for purposes of
website accessibility
