Jackson, MI Pediatric Dentistry

(517) 787-10223386 Spring Arbor Road, Suite 2, Jackson, MI 49203

For Referring Providers

Submit a Patient Referral

Pediatricians, family physicians, and general dentists can submit a referral here. We will contact the family within one business day to schedule. For urgent referrals, call us at (517) 787-1022.

Referring Provider
Patient
Reason for Referral

Do not include detailed PHI (treatment notes, imaging) in this form. We will contact you through a HIPAA-compliant channel for clinical handoff.