Edit, Download, and Sign the Florida Dental Implants & Oral Surgery Referral Form
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How do I fill this out?
To fill out this form, begin by entering the patient's personal information. Next, provide details of the referring doctor and chosen procedures. Finally, follow the instructions for anesthesia and other requirements.
How to fill out the Florida Dental Implants & Oral Surgery Referral Form?
1
Enter the patient's name and date of birth.
2
Fill in the appointment date and referring doctor's information.
3
Specify the types of procedures being referred.
4
Complete the special instructions section if applicable.
5
Ensure all sections are filled out clearly.
Who needs the Florida Dental Implants & Oral Surgery Referral Form?
1
Patients seeking dental implants to understand the procedure.
2
Referring doctors needing a structured format for patient referrals.
3
Orthodontists requiring clear information for specialist referrals.
4
General dentists wanting to provide their patients with the best resources.
5
Administrative staff in dental offices processing patient referrals.
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What are the instructions for submitting this form?
To submit this form, email it to referrals@floridadentistry.com or fax it to 863-665-1096. For physical submission, visit our office at 2150 Harden Blvd, Lakeland, FL 33803. Please ensure all fields are complete before submitting to avoid delays.
What are the important dates for this form in 2024 and 2025?
Important dates for 2024 and 2025 will include new patient intake periods and deadlines for submission of this form. Ensure you stay updated for any revisions to these timelines. Regularly check for updates as dental procedures and availability may change.
What is the purpose of this form?
The purpose of this form is to streamline the referral process for dental implants and oral surgery in Florida. By gathering essential patient information and provider details, it ensures clear communication between referring doctors and specialists. This facilitates better patient care and understanding of procedures.
Tell me about this form and its components and fields line-by-line.
- 1. Patient Name: The full name of the patient.
- 2. Date of Birth: The patient's date of birth for identification.
- 3. Appointment Date: The scheduled date for the procedure.
- 4. Patient Telephone: The patient's contact number.
- 5. Referring Doctor: The doctor who is making the referral.
- 6. Special Instructions: Any additional notes regarding the patient's care.
- 7. Procedure Types: Options like implants, extractions, etc.
What happens if I fail to submit this form?
Failing to submit this form may lead to delays in your dental procedure. It's important to provide complete information to avoid scheduling issues. Incomplete forms can result in missed appointments and additional follow-ups.
- Scheduling Delays: Without a completed form, appointments may be postponed.
- Lack of Medical History: Incomplete details can hinder proper patient evaluation.
- Missed Opportunities: Patients may miss out on timely dental procedures.
How do I know when to use this form?
- 1. Dental Implants Referral: For patients needing dental implants and assessments.
- 2. Oral Surgery Cases: For surgical procedures requiring specialist input.
- 3. General Dental Referrals: When general dentists refer to specialists.
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