Lexington Endodontics Referral Form

We are ready to receive HIPPA protected information directly from your computer; you do not need to have secure email at your office. If you do not have a user name and password simply call us and we will provide them to you, this information will allow you to login under the Multidisciplinary Doctors portal . Using this feature you can securely access the real time patient referral service available to you by our digital office software.

For a paper copy of our referral form please click on the image below and print the form. If you do not have Adobe reader, click here for a free download.