Thank you for referring your patient to the Dr. Gerald Niznick College of Dentistry. We are currently accepting referrals for Radiology, Graduate Orthodontics, Graduate Periodontics, Graduate Prosthodontics, Graduate Oral Surgery, TMD, DSM and Oral Pathology. When referring a patient, it is the provider’s responsibility to inform the patient of the exact purpose of the referral. The patient should understand that they may not necessarily be accepted for treatment at our clinics. To avoid delay in the diagnosis and treatment of your patient, please complete this form in full.
Please note this referral is for limited treatment only, comprehensive care would continue at your private practice clinic.