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Aloha Dental Specialty Center
18455 SW Alexander St, Suite B, Beaverton, OR 97006
Mon-Wed: 8AM-5PM | Thu-Fri: 8AM-6PM | Sat: 8AM-2PM | Sun: Closed
(503) 822-0096
Schedule Online

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 Form Below Download PDF Form

Fill Out Online

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

Go to Form

Download PDF

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

Download PDF

Refer via DentalRefer

Already on DentalRefer? Submit a referral to our office through our secure DentalRefer profile.

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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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Visit Us 18455 SW Alexander St, Suite B
Beaverton, OR 97006
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Call Us (503) 822-0096
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Office Hours Mon-Wed: 8AM-5PM | Thu-Fri: 8AM-6PM | Sat: 8AM-2PM | Sun: Closed
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Ready to Explore Your Dental Referral Form Beaverton in Beaverton, OR Options?

Schedule a no-obligation consultation with our multi-disciplinary dental team. We'll review your case, explain your options, and create a personalized treatment plan.

Schedule Consultation Call (503) 822-0096

Referring Doctors: Submit a Referral →

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

    🔒 Your information is secure and confidential

    📞 Or call us now: (503) 822-0096

    18455 SW Alexander St, Suite B, Beaverton, OR 97006

    Board Certified Endodontist & Pediatric Dentist
    Top Rated Comfort-First Care
    Advanced Tech 3D CBCT & AI Design
    Referral Center Trusted by Dentists