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Referral Form

Thank you for referring your patient to Santa Rosa Oral Surgery. Please complete the form below to send patient and referral information to our oral surgeons. If you have any questions, call our team at 707-545-4625.

Printable Referral Form

Printable Referral Form

Online Referral Form

Referral Information

This time is reserved specifically for you. If by necessity you must cancel your appointment, the courtesy of at least 48 hours advance notice is appreciated. Any unmarried patient under 18 years of age must be accompanied by a parent or guardian for all appointments.

Please Evaluate For The Following Treatment
Adult Tooth Chart
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Child Tooth Chart
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Appointment Request

Take the next step toward healthier function, greater comfort, and renewed confidence with care designed around your needs. Whether you have been referred for oral surgery in Santa Rosa, CA, are exploring dental implants, or need prompt attention for wisdom teeth or extractions, our team is ready to help. We explain your options clearly, answer questions thoroughly, and make scheduling simple so you can begin treatment with peace of mind today with confidence and clarity throughout treatment.

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