Office Referrals

Patient referrals from general dentists, oral surgeons, endodontists, prosthodontists and orthodontists are welcomed. If you'd like to refer one of your patients to our office for an examination, please contact us at (908)218-0770 or smile@kandcperio.com.

You may also use our printed form when you need to refer your patient to us. You may enter the information and save to encrypted email or print to fax. Send completed referral forms by fax to (908)218-9789 or email smile@kandcperio.com.

Thank you for your support in our dental implant and periodontic practice.

Referral Formv2.jpg

Dear Doctor,

Please kindly filled the form below and we will contact you shortly. Thank you. - Tyler Kim & Tat Chiang

Referring Doctor's Name

Office Phone Number

(###)

###

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Office Email Address

Patient's Name

First Name

Last Name

Patient's Phone Number

(###)

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Message