Refer A Patient to Elkhart Periodontics

Elkhart Periodontics welcomes referrals from dentists and medical professionals throughout the Michiana region. Our team coordinates directly with your patient, provides specialized periodontal care, and keeps your office informed throughout the treatment process.

(574) 266-6107

A Simple, Collaborative Process

We make referring a patient to Elkhart Periodontics straightforward and efficient. Once a referral is submitted, our team takes care of the next steps while keeping your office informed throughout the process.

01
Referral Received

We review your referral and contact the patient to coordinate their consultation.

02
Specialized Care Provided

Your patient receives comprehensive periodontal care tailored to their needs.

03
Ongoing Communication

Your office receives updates and follow-up information throughout treatment.

Submit a Patient Referral

Please complete the form below to refer a patient to Elkhart Periodontics. Our team will coordinate directly with your patient and follow up with your office as care progresses.

Provider Type*

Provider Name*

Practice/Organization Name*

Provider Email*

Provider Phone*

Patient Name*

First Last

Patient Email*

Patient Phone*

Reason for Referral*

Gum loss and/or recession

Periodontal disease

Peri-implantitis

Crown lengthening

Other

Additional Notes/Clinical Information

*This form is for referral coordination only and does not transmit sensitive medical records. Additional documentation may be requested as needed.

Questions About Referring A Patient?

If you have questions about the referral process or would prefer to speak with our team directly, please call our office. We’re happy to assist.