Refer a Patient

Fast, secure referrals to our endodontics, oral surgery, periodontics, and orthodontics teams. Attach radiographs and notes—our coordinators will contact your patient the same business day.

Submit referral Include radiographs & notes
We contact patient Same business day
You get updates Reports & follow-ups sent
HIPAA-conscious secure form
Encrypted file upload
Same-business-day patient outreach

    Secure Referral Form

    Fields marked with a * are required. Please include recent radiographs and any relevant notes.


    Referring Provider - Step 1 of 4

    Patient Information - Step 2 of 4

    Referral Details - Step 3 of 4

    Attachments & Notes - Step 4 of 4

    Accepted formats: PDF, JPG, PNG, TIFF — up to 10 MB per file. Multiple files accepted.
    I confirm I have obtained the patient's consent to share health information with TCD Specialty Group for coordination of care.

    🔒 Encrypted & HIPAA-conscious — Patient contacted by end of business day.