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Online Referral Form

Submit a patient referral securely online. Our referral coordinator will contact the patient within 1 business day to schedule their appointment.

Fill Out Online

Complete the secure referral form below. We will receive it instantly and contact the patient within 1 business day.

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Download PDF

Download the referral form as a PDF. Print, fill out, and fax or email it to our office.

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Secure Online Referral Form

Fields marked with * are required. All information is transmitted securely.

Referring Doctor Information
Patient Information
Referral Details
Clinical Notes
X-Rays & Records

Drag & drop files here or browse files

Accepted: JPG, PNG, PDF, DICOM, ZIP (max 10MB each, up to 5 files)

By submitting this form, you confirm that you have obtained the patient's consent to share their information for referral purposes. This form is transmitted securely.

Other Ways to Refer

Choose whichever method is most convenient for your practice.

Call Us

(503) 822-0096

Speak directly with our referral coordinator

Email

[email protected]

Send referral details and attachments

Fax

Call for Fax Number

Fax the completed PDF referral form

Questions About the Referral Process?

Our referral coordinator is happy to assist. Call us or visit our referring doctors page for more information.

(503) 822-0096
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Call Us (503) 822-0096
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Ready to Explore Your Dental Referral Form Beaverton in Beaverton, OR Options?

Schedule a no-obligation consultation with our board-certified specialists. We'll review your case, explain your options, and create a personalized treatment plan.

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Aloha Dental Specialty Center — Your Trusted Multi-Specialty Dental Team

    Board Certified Specialty Specialists
    Top Rated 5-Star Patient Reviews
    Advanced Tech 3D CBCT & AI Design
    Referral Center Trusted by Dentists

    Trusted by Beaverton Patients

    ★★★★★

    Over 500+ Top-Rated Reviews for our Specialty Dental Care

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    "Dr. Ostovar is incredibly meticulous. I was nervous about getting dental implants, but the entire process was seamless and painless. The technology they use here is incredible. Highly recommend this specialty center."

    SM
    Sarah M. Dental Implants Patient
    ★★★★★

    "I was referred to Dr. Gobazden by my general dentist for oral surgery. From the consultation to the post-op care, the entire team was professional and comforting. This is a top-tier oral surgery practice."

    JT
    James T. Oral Surgery Patient
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