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Prosthodontics (crowns, bridges, dentures and implants) referral form; Missing information may result in a processing delay. An urgent referral needs to be seen within 48 hours and a patient will be asked to: Copy of your insurance card is required in order to schedule appointment.

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Web referral scheduling form for psychiatric and counseling referrals, please complete a release form at the central desk. Fill out and fax the referral form and clinical documentation to: Start completing the fillable fields and carefully type in required information. Provide a copy (both front and back) of an insurance card;

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