Thank you for trusting us with your patients.

Our goal is to make the process easy and seamless to refer your patients to our practice. We will treat your patients like family and meet their health needs and exceed their expectations.

Please complete the form below. If you have any questions before sending your patients to our practice please do not hesitate to reach out to us 360-979-1537.

  • Date Format: MM slash DD slash YYYY
  • Requested Services

  • TMJ

    Please check all that apply for the patient being referred:
  • Sleep Disorders

    Please check all that apply for the patient being referred: