Charlotte, Concord & Lake Norman Oral Surgeons
704-347-3900
Open Hours: Mon-Thurs 8am-5pm Fri 8am-2pm

Referral Forms

For Physicians

Physician referral forms are located here. Please use one of the following forms to refer a patient to Carolinas Center For Oral & Facial Surgery.

This is the General Physician Referral Form. Fill out and submit this PBHS form for all of your patient referrals to us. (Opens in new tab). You may also download the .PDF and send it in via fax or email.

This is the Orthognathic / TMJ Referral Form. Please use this form to refer TMJ / Orthognathic patients to our practice. (Opens in new tab). You may also download the .PDF and send it in via fax or email.

This is the Dental Implant Referral Form. Please use this form to refer dental implant patients to our practice. (Opens in new tab). You may also download the .PDF and send it in via fax or email.

**NEW** This is the Envision Implant Referral Form. Please use this form to refer dental implant patients to our practice. (Opens in new tab). You may also download the .PDF and send it in via fax or email.

For Patients

Contact our office during regular hours Monday-Friday 9 Am – 5 PM to talk with one of our new patient coordinators today! We ask that all new patients please use the registration form below to formally submit your information to us.

Download the new patient registration forms here (opens in new tab).

Next, save the form as .pdf, then fill it out and bring it with you to your first visit.

This is the online new patient registration. You can optionally fill this form out to submit your registration before your appointment (Opens in new tab). 

*Use of these links and submission of information is subject to the HIPPA Notice of Privacy Practices. Submission of information should be seen as an acknowledgement of each patient’s rights under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) (Opens in new tab).