Please locate the service needed for your patient and use the appropriate means below to begin the referral process or to find out more about the services offered by the University of Michigan School of Dentistry.
If you have a technical problem with a referral form, please use the "Provide Feedback" link near the top of the page. If you have questions for a specific department or regarding a certain patient, please use that department's websitt link below to find contact information (or use the phone number if provided below).
| DEPARTMENT/SPECIALTY | REFERRAL REQUEST FORM | |
|---|---|---|
|
Comprehensive Clinical Pathology Services
Please use this form if you would like our team to evaluate and manage diseases affecting the oral and maxillofacial regions. These include (but are not limited to): autoimmune diseases (lichen planus, mucous membrane pemphigoid, etc and others), dry mouth, burning mouth syndrome, oral manifestations of systemic disease (Crohn’s disease, etc), fungal infections (candidiasis) leukoplakia and other pigmented lesions, neoplastic and reactive lesions (tumors and masses), or oral cancer. We will also determine if a biopsy is needed and help your patient get the additional recommended testing. |
CCPS Form | |
| CBCT Form | ||
| Dental Faculty Form | ||
| (734) 763-6933 | ||
| Endo Form | Endo Form | |
| GradRest Form | ||
|
Hospital-Based and Special Care Dentistry
Providing comprehensive dental care for patients ages 16 and above in a hospital or specialized setting for patients with special healthcare needs and/or medical complexity, including the treatment of oral infections, trauma, cancer, and comprehensive dental care for patients with complex dental treatment needs. Hospital Dentistry at Michigan Medicine website Delta Dental Integrated Special Care Clinic at the School of Dentistry |
HDISCC Form | |
| Obstructive Sleep Form | ||
|
Outpatient Oral & Maxiollofacial Surgery at the School of Dentistry
Providing exposures, extractions (including wisdom teeth), implants, alveoplasty, frenectomy, tori removal, and biopsies (Hard or Soft Tissue, Infection, Drainage, etc.) Oral & Maxiollofacial Surgery (Dentistry) website |
OMFS Form | |
|
Oral Pathology Biopsy Service
Please complete this form only when you have a specimen (in formalin or other medium) to submit. If you would like a patient to be evaluated for pathology with a possible biopsy or additional testing, please use this form: (Comprehensive Clinical Pathology Services) Oral Pathology Biopsy Service website |
Biopsy Form | |
|
Adult Oral & Maxillofacial Surgery at Michigan Medicine
Providing adult surgical care for head and neck cancers; skeletal anomalies; jaw conditions; trauma reconstruction; and wisdom teeth extraction. Oral & Maxillofacial Surgery/Dentoalveolar website |
OMFS MM Form | |
|
Pediatric Oral & Maxillofacial Surgery at Mott Children's Hospital
Providing pediatric surgical care for head and neck cancers; skeletal anomalies; jaw conditions; and trauma reconstruction. Oral & Maxillofacial Surgery/Dentoalveolar website |
OMFS MCH Form | |
|
Orthodontics Clinic
Orthodontics Clinic website Please call the orthodontics clinic for any external referral-related questions or requests 734-764-1520 |
734-764-1520 | |
| Peds Form | ||
| Perio Form | ||
| Prosth Form | ||
|
Temporomandibular Disorders and Orofacial Pain Clinic
Providing a thorough assessment and diagnosis of orofacial pain to provide management through a comprehensive and multidisciplinary approach. Temporomandibular Disorders and Orofacial Pain Clinic website |
TMD/OP Form | |
|
Hospital-Based Wisdom Tooth Clinic
Providing wisdom tooth extractions in a hospital setting for medically complex cases. On April 23, 2023, the Wisdom Tooth Clinic referral form will no longer be available. All wisdom tooth extraction referrals should be sent using the "Outpatient Oral & Maxillofacial Surgery at the School of Dentistry" form above. |
WT Form |
Updated 2023-08-14
