REFERRAL FORM
REFERRAL FORM
Two kinds of referral forms are provided for you, so that you can print and fax or e-mail as an attachment to our office or have the patient bring the completed form with them to their visit to our office.
Our fax number is (928) 704-0442. Our e-mail address is: drthomasperio@gmail.com
The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it.
This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.
Please contact us if you have any questions or would like to schedule an appointment.
MICHAEL E. THOMAS, DDS MS
Specialist In Periodontics & Dental Implants
SERVING ALL OF MOHAVE COUNTY & SURROUNDING AREAS
928.704.0440 (Bullhead) | 928.854.7698 (Lake Havasu) | 1.800.446.2288 | drthomasperio@gmail.com