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Paladin Dental Referrals

If you plan to refer a patient to our practice, please complete the form below.

Paladin Dental Referral

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Patient Information

Patient's name*
MM slash DD slash YYYY
Does the patient require antibiotics prior to dental treatment?*
Please call patient*

Referring Doctor Information

Referred by*

Procedures

Extractions*
Full-mouth implants*
Single implant*
Bone grafting*
Sedation*

Extracting Information

tooth number chart

Radiographs or Clinical photos

Radiographs / Clinical photos*
Max. file size: 6 MB.

Case Notes

Paladin Dental

2747 W Bullard Ave, #103
Fresno, CA 93711
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Hours

Monday: 7:00 a.m.-5:00 p.m.
Tuesday: 7:00 a.m.-5:00 p.m.
Wednesday: 7:00 a.m.-5:00 p.m.
Thursday: 7:00 a.m.-5:00 p.m.
Friday: 8:00 a.m.-12:00 p.m.
Saturday: Closed
Sunday: Closed

Phone

559-436-8288

Email Address

[email protected]

Paladin Dental
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