Skip to content
Call
Text
Email
Portal
Home
About Us
Our Practice
Meet Dr Patel
Our Team
Adopt an Astronaut
Smile Transformations
Community Service
Why Choose Us?
Treatments
Invisalign
Invisalign For Adults
Invisalign For Teens
Invisalign for Kids
Braces
Lightforce Braces
Braces for Adults
Braces for Teens
Braces for Kids
Qlear Smile Aligners
Early Orthodontics
Adult Orthodontics
Sleep Apnea
TMJ Treatment
MARPE
Resources
Your First Visit
Insurance & Financing
Emergency Care
Smile Explorers Club
Lifetime Smiles Guarantee
Happy Tooth Blog
Patient Portal
Contact Us
Refer a Friend!
Dentist Referral Form
Contact Us
Decatur Office
Sandy Springs Office
Home
About Us
Our Practice
Meet Dr Patel
Our Team
Adopt an Astronaut
Smile Transformations
Community Service
Why Choose Us?
Treatments
Invisalign
Invisalign For Adults
Invisalign For Teens
Invisalign for Kids
Braces
Lightforce Braces
Braces for Adults
Braces for Teens
Braces for Kids
Qlear Smile Aligners
Early Orthodontics
Adult Orthodontics
Sleep Apnea
TMJ Treatment
MARPE
Resources
Your First Visit
Insurance & Financing
Emergency Care
Smile Explorers Club
Lifetime Smiles Guarantee
Happy Tooth Blog
Patient Portal
Contact Us
Refer a Friend!
Dentist Referral Form
Contact Us
Decatur Office
Sandy Springs Office
Primary Care Dentist Referral Form
Referring Doctor Name
Practice Name
Practice Phone
Practice Email
Patient First Name
Patient Last Name
Date of Birth
Parent/Guardian Name (if minor)
Patient/Guardian Phone
Patient/Guardian Email
Chief concern/Reason for referral
Malocclusion Type (check all that apply)
Crowding
Spacing
Overbite
Underbite
Crossbite
Open Bite
Midline discrepency
Impacted Teeth
TMJ issues
Sleep/Airway
Additional Clinical Notes
Urgency Level
Not Urgent
Low
Middle
High
Send
