Post Falls Periodontics. Coeur d’Alene Periodontics. Oral Surgeon in Post Falls. Oral Surgeon in CDA. Coeur d’Alene Perio. Dental Implant Surgeon in Post Falls. North Idaho Periodontics. Post Falls Perio.

602 North Calgary Ct., Suite 102
Post Falls, ID 83854

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208.777.1796

REFERRALS

Post Falls Periodontics

Referring providers: Please complete the below secure referral form to communicate how we can best help your patient. We look forward to working with you in restoring and maintaining your patient’s oral health.

Introducing:

Referred by Dr.:

E-mail:

May we call the patient:

Yes

Daytime Phone:

Reason for referral:

Periodontal Disease Evaluation
(Please send current Perio chart if available)
History of Scaling and Root Planing?

Date:

Implant Consultation

Tooth/Teeth #

Crown Lengthening

Tooth/Teeth #

Functional

Esthetic

Gingival Recession/Connective Tissue Grafting
(Please send current Perio charting if available)

Tooth/Teeth #

Other

Dr. McCombs to take
needed x-rays:

Comments:

Appointment Date:

Time:

602 North Calgary Ct. Suite 102
Post Falls, ID 83854

208.777.1796

HOURS
Mon-Thurs
8am-4pm




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