Sample Referral Form

Using a dental referral form allows you to recommend treatments that you know are safe and promote two way communication with the dentist. You can also refer the dentist to the New York and California Guidelines (click the thumbnail images below to access).


Oral Health Care During Pregnancy and Early Childhood Practice Guidelines. New York Public Health Department, 2006.

Oral Health During Pregnancy and Early Childhood: Evidence Guidelines for Health Professionals. California Dental Association Foundation. February 2010.