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Call 631-661-6633 | Email Dr. Scharf and ask your dental question

Periodontal Email Referral Form

First Name:
Last Name:
Referred By:
Phone:
Email:
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Complete Periodontal Evaluation
REASON FOR REFERRAL
RADIOGRAPHS
Implants
Gingival Recession
IMPLANTS
Graft For Root Coverage
Crown Lengthening
SURGICAL TEMPLATE
Guided Tissue Regeneration
Gingival Contouring For Cosmetics
Ridge Augmentation
Other

 

PERIODONTAL TREATMENT COMPLETED IN YOUR OFFICE
Plaque Control Instruction
Prophylaxis and Gross Scaling
Root Planing
Periodontal Maintenance Therapy

Have you advised the patient of the possibility of extraction of any teeth? If yes, which tooth numbers?

Tooth #s:

Is there any restorative dentistry that needs to be completed?

COMMENTS:

Visit our patient letters section and read actual letters sent to Dr. Scharf by his patients.

Website content ©2000 David R. Scharf, D.M.D., All Rights Reserved
98 East Main Street, Babylon, New York 11702
Phone (631) 661-6633 · Fax (631) 661-6645
Site maintained by TNT Dental

Home | Meet Dr. Scharf | Patient Information | Dental Implants | Periodontal Disease
Perioscopy | Tour of Services | Patient Letters | Photo Gallery | Office Map
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David R Scharf DMD is a Periodontist in Babylon on Long Island. His Periodontal Services include dental implants, tooth cleaning, perioscopy, gingivectomy, periodontics, plaque removal, and soft tissue reconstruction. Serving the Babylon, Long Island, New York area.