Thank you for considering the Case Western Reserve University School of Dental Medicine Dental Clinic for your patient referral! Please assess that your patient is in need of a referral to one of our specialty departments. If that is the case, please then complete the following steps:
- Download a copy of the fillable adult referral form or the fillable pediatric referral form.
- Complete the form and remember to save your changes to the file.
- Upload your completed form to the field below.
Referrals require the following information:
- Clear instructions from the exam that was done by the referring provider
- A diagnosis
- The name of the specialty department to which the patient is being referred
- The name of the referring provider
- The office location of the referring provider
- The phone number of the referring provider
- The patient's name
- The patient's date of birth
- The patient's phone number
For referrals to be processed and patients contacted, each of the above the above must be provided.