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 |
| CBCT Form | |
| Coming soon | |
| (734) 764-3155 | |
| (734) 763-6933 | |
| Endo Form | |
| (734) 764-1532 | |
|
Hospital-Based and Special Care Dentistry
Providing comprehensive dental care in a hospital or specialized setting for patients with special healthcare needs and/or medically complexity, including the treatment of oral infections, trauma, cancer and comprehensive dental care for patients with complex dental treatment needs. Hospital-Based and Special Care Dentistry website |
HB/SC Form |
| OSA Form | |
| OMFS Form | |
| Biopsy Form | |
|
Hospital-Based Oral & Maxillofacial Surgery
Providing surgical care for head and neck cancers; skeletal anomalies; jaw conditions; and trauma reconstruction. Oral & Maxillofacial Surgery/Dentoalveolar website |
HB/OMFS Form |
| 734-764-1520 | |
| Peds Form | |
| Perio Form | |
| Prosth Form | |
|
TMD/Orofacial Pain Clinic
Providing a thorough assessment and diagnosis of orofacial pain to provide management through a comprehensive and multidisciplinary approach. TMD/Orofacial Pain Clinic website |
TMD/OP Form |
|
Hospital-Based Wisdom Tooth Clinic
Providing wisdom tooth extractions in a hospital setting for medically complex cases. TWisdom Tooth Clinic website |
WT Form |
Updated 2021-09-28
