Your patient will be contacted within 24 hours to schedule an appointment. Please feel free to contact our office at 972-527-GUMS(4867) if emergency care is needed.
Thanks again for entrusting us with your surgical referrals!
Email X-Rays or Photos to
info@implantspecialists.com
Fax Referral Form
Patient Name:
Courtesy of Doctor/Staff:
Patient Address:
Referring Doctor Email:
Patient Phone:
Referred Doctor Phone:
Referred To:
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Nabil E. Beaini, DDS, BS
Dr. Edward A. Shinedling, DDS, MS
Nature of Referral and Other Important Information: