Doctor Referral Form

Doctor Referral Forms for Endodontics, Periodontics, or Orthodontics

For referring doctors’ office use only.

You may refer patients to our Huntington Beach office by completing the online form below, or by downloading and printing the appropriate referral form. After completing the printed form, please fax it to 714-375-2199.

Doctor Referral Form

At Farsio Dental Specialties Group, we value our relationships with referring dental practices and are proud to partner with you to provide excellent oral healthcare to our community.

To optimize care for our shared patients, we:

  • Review cases thoroughly in advance
  • Refer back to your office for restorations
  • Collaborate with you on treatment plans
  • Are available in an advisory role if requested
  • Offer accommodating scheduling
  • Provide timely assessments and imaging

If you have any questions about our practice, please feel free to contact us. Above all, we want to thank you for your referral to our office.

    Referral Information







    Specialty Referral


    Orthodontics



    Periodontics

    Tooth Selection

    *Please select each tooth below*

    Molars

    Bicuspids

    Anteriors

    Anteriors

    Bicuspids

    Molars




    Endodontics

    Tooth Selection

    *Please select each tooth below*

    Molars

    Bicuspids

    Anteriors

    Anteriors

    Bicuspids

    Molars





    If you have any questions, please call our office.

    Office Hours

    Monday through Friday: 9:00 AM - 6:00 PM
    Saturday: 7:00 AM - 3:00 PM

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    (714) 847-3513

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      Office Hours

      Mon - Fri:
      9 am to 6 pm
      Sat:
      7 am to 3 pm

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