Referring Doctors

Referring Forms

The frenectomy/tongue-tie forms are designed to be filled out BY THE PARENT. Based on the responses, providers can determine whether a referral is recommended. Please feel free to call us if you have questions.

Dear Colleague,

Thank you for your trust in allowing us to be a part of your team. We look forward to working together to achieve optimal oral health for your patient!

There are several components we investigate to formulate the appropriate, individualized plan for each child. Specifically, we thoroughly assess the medical health of the child, including:

  • Medical conditions
  • Medications
  • Weight/BMI
  • Tonsillar assessment
  • Special needs
  • Caries risk (including oral hygiene and dietary habits)
  • Growth and development patterns
  • Extent of treatment needed
  • Behavior/ability to tolerate treatment needed
  • Any other contributing issues (bruxism, oral habits, hypoplastic enamel, etc)

Based on the cumulative findings above, we may propose:

  • No treatment/monitor conditions
  • Treatment with nitrous oxide
  • Treatment with oral conscious sedation
  • Treatment with IV sedation

Learn more about our Relaxation Treatments >
Learn more about our Safety Protocols >

Again, we thank you for the privilege of working with your patients!

Please email x-rays, referral forms, or additional information to

8870 N MacArthur Blvd Ste A-101
Irving, TX 75063
(214) 484-3199
Text or call!
By appointment only
7:15am to 2:00pm
7:15am to 4:00pm
7:15am to 4:00pm
7:15am to 2:00pm
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