Select a Referral Type Above

The available referral services are listed below (more are in the process of being added). Most services will provide a downloadable PDF. But some referrals also have an online form you can use. The dropdown menu at the top of this page includes our available online forms.

Type Phone PDF Online
Cone-Beam Computed Tomography 734-764-3155 CBCT Form
Endodontics 734-764-1540
Oral & Maxillofacial Surgery
(School of Dentistry)
Extractions, Implants, Alveoplasty, Tori Removal, Pathology Services
734-764-1568 OMFS Form
Oral & Maxillofacial Surgery
(University Hospital)
734-936-5950 Oral Surgery Patient Referral Form (PDF) Oral Surgery
Wisdom Tooth Clinic
(University Hospital)
734-936-5955 Wisdom Tooth Clinic Referral (PDF) Wisdom Tooth
TMD Orofacial Pain
(University Hospital)
734-936-5955 TMD and Orofacial Pain (PDF) TMD Orofacial Pain
Hospital Dentistry
(University Hospital)
734-936-5950 Hospital Dentistry (PDF) Hospital Dentistry
Orthodontics
(School of Dentistry)
734-647-8824
Pediatric Dentistry
(School of Dentistry)
734-764-1523 Peds Form

Update: 05-21-2018