Online Referral Form

Oral Surgeons of Charlotte – Charlotte NC

You may refer patients to our office by filling out our secure online Referral Form. After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it.


On-line referral form

Please call us with any questions or to schedule an appointment.

Charlotte Office Phone Number 980-224-7737      Schedule an Appointment     Map & Directions