Online referral form
Complete and submit the form below to refer a patient. If you prefer a paper form, use the Print Referral button to open the fillable PDF.
Phone: 913-642-3636Fax: 913-642-5066Email: kcendodontics@gmail.com
Print ReferralOpens the printable PDF in a new tab.
Print ReferralOpens the printable PDF in a new tab.
If the form does not load,open the referral form in a new tab.
Office contact
- Phone: 913-642-3636
- Fax: 913-642-5066
- Email: kcendodontics@gmail.com
- Address: 3700 W. 83rd Street, Suite 106, Prairie Village, KS 66208
For time-sensitive referrals, pain, swelling, or dental trauma, please call rather than relying on a document alone.
Helpful referral details
Including the following can reduce back-and-forth and help the patient’s first visit proceed smoothly:
- The tooth or area of concern
- The reason for the referral
- Relevant treatment history
- Recent images
- Restorative plans or limitations
- Preferred treatment scope
- Best contact information for follow-up