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Orthodontic Evaluation Referral Form

Thank you for referring your patients to the Orthodontic Specialists of Lake County for their orthodontic needs! We appreciate your trust and look forward to taking great care of your patients.

Submit your referral using the online form below.

Field marked with * is important

Referring dentist details

Patient details

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Request your free appointment

No time to come in and see us? Book a free virtual consultation instead.

*We do not accept Medicare or Medicaid
By submitting this form, you are agreeing to our privacy policy.