Refer your patient in seconds! Simply click the "Contact" button below to complete our fully HIPAA-compliant, secure pop-up form via SimplePractice using these steps:
- "Your Info": Please enter your professional contact details (name, phone, and email) so that we can follow up with you.
- "Client’s Info": Provide the patient’s name, DOB, phone number, and state.
- Under "Client Preferences," "Is there anything the practitioner needs to know?”, please include the reason(s) for the referral (e.g., speech delay, difficulty saying R sounds, lisp, tongue thrust swallow, anterior open bite, tongue tie).