Dentist Referrals Check out our Newsletter > Download Printable Referral Form > Dentist Referral X/TwitterThis field is for validation purposes and should be left unchanged.Referred toFirst AvailableDr. Bill ScruggsDr. Anthony GraggDr. Cristen AyersReferred By (name)Office PhoneOffice Email PatientPatient Name First Last Patient DOB Patient Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Patient Cell PhonePatient Other PhoneReferred For: Complete Denture Partial Dentures Immediate Dentures Overdentures Full Arch Implant Bridge/Hybrid Other Referred For NotesMedical AlertReferral DetailsRadiographs Please Take FMX being sent Prior X-Rays available Existing Radiographs: Please send existing imaging to our New Patient Coordinator at [email protected]Appointment Status Our office to call patient and coordinate appointment (Preferred Method) Patient will call our office to schedule appointment. Need our office to call your office before we see the patient.