Bend Children's Dentistry

Learn More About

Patient Referral

Complete & Submit Form

You can refer patients to our office by filling out and submitting the below Patient Referral Form.
(Dental Offices: please attach X-rays with referral form. Medical Offices: please just fill out the referral form.)

Questions regarding referrals? Give us a call at (541) 907-1611 or email at [email protected]

Request an Appointment

Please provide your details below and we will contact you to schedule your appointment