New Patient Referral

If you landed on this page then an existing patient was kind enough to refer you to our practice...we're happy you've decided to join us!  Please complete the quick form below in order to complete the referral and we'll get in touch with you as soon as possible in order to schedule your introductory exam and cleaning with Dr. Emily Gentry.  We look forward to meeting you soon!

Name *
Name
Phone *
Phone