Online Referral

Thank you for choosing East Valley Periodontics.

Our goal is to make referring your patients to us as simple as possible.

---

1. Complete a Referral:

   Referral Options:

   • Secure Online Referral Form (opens secure external referral portal in a new window)  

     Enter your patient's information in the first screen and be sure to select yes with X-Rays to submit:

     • Dental Insurance
     • Most Reccent FMX
     • Any Additional X-Rays
     • Photos
   • Email Directly

     send directly to:   or  

   • Paper Referral
     Request Paper referral pads for your office. (opens secure external request portal in a new window)  

2. Request an Appointment:

   Options for our Mesa Location:

   • For existing periodontial patients wanting to scheduled your next cleaning? (opens secure external forms portal in a new window)  
   • Schedule an exam with a Periodontist for any periodontial or bone loss concerns (opens secure external forms portal in a new window)  
   • Schedule an exam with a Periodontist for any other concerns. (implants, recession/tissue grafting, biopsy, etc.) (opens secure external forms portal in a new window)  

   Options for our Queen Creek Location:

   • Online requests coming soon. Please contact the office at (480)988-6609.