Information for Referring Doctors

The following forms can be used for a variety of referral needs. If you require assistance with these forms, please contact our webmaster.

Services requiring a referral

Endodontics (Root canals)

    Geriatric Oncology Dental Clinic

    Oral and Maxillofacial Pathology Services

    Oral and Maxillofacial Surgery

    Please note

    Please complete the referral form in its entirety so we have the necessary information to review your referral. The referring dentist will be notified directly (preferred email address) for any referral we cannot accept. Our office staff will call your patient if the referral is accepted.

    This form is not meant to be printed or hand written. Please dispose of any old referral forms you may have.

    Email the completed referral form to

        Periodontics (Gum disease)

          Prosthodontics (Crowns, bridges, dentures and implants)

          Radiology (X-ray services)

              Ohio State Dental Faculty Practice 

              Upper Arlington Dentistry (off-campus clinic)

              The following services do not require a referral:

              General Practice Residency (General Dentistry)

              Orthodontics (Braces, bite correction)

              Pediatric Dentistry

              Dental Emergency Care Clinic

              7:30 a.m.-12 p.m.

              7:30 a.m.-10:30 a.m.

              Student Dental Clinics

              8:00 a.m.-4:00 p.m.

              Ohio State Dental Faculty Practice

              7:30 a.m.-4:30 p.m.

              Upper Arlington Dental Clinic

              7:30 a.m.-5:30 p.m.

              7:30 a.m.-4:30 p.m.

              7:30 a.m.-12:30 p.m.