Online Referral Secure Portal for Practices

Secure Online Referral Form

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

Clinical Referral Guidelines for Dental Practices

At Aloha Dental Specialty Center, we strive to make patient transitions as seamless and effortless as possible for referring clinicians and administrative teams. When you refer a patient for specialty evaluation — whether for dental implant placement, LANAP laser periodontics, microscopic root canal therapy, or pediatric dental care — our team treats your patients with warmth, clinical precision, and utmost respect.

HIPAA-Compliant Digital Data Transmission

Our online referral portal is engineered to meet the highest federal security standards under the Health Insurance Portability and Accountability Act (HIPAA) and HITECH omnibus rules. All form inputs, clinical text notes, and radiographic attachments are encrypted in transit using 256-bit Secure Socket Layer (SSL/TLS) encryption. Digital radiographs and DICOM files are stored in access-controlled, BAA-backed cloud repositories accessible only to credentialed clinicians and direct care coordinators.

Recommended Referral Documentation Checklist

To allow our specialists to conduct a comprehensive initial evaluation and avoid redundant diagnostic exposure for the patient, we encourage your team to include:

• Current Diagnostic Radiographs: Recent periapicals, bitewings, or panoramic films taken within the past 6 to 12 months. If you have an existing 3D CBCT volume, you may upload the zipped DICOM file directly through our form.
• Specific Teeth Numbers & Chief Complaint: Clearly identify the target tooth (#1 – #32) or quadrant, noting whether the patient is experiencing acute pain, swelling, occlusal tenderness, or purulent drainage.
• Restorative Plan & Implant Preferences: For implant referrals, indicate your long-term restorative design (e.g., screw-retained vs. cement-retained crown, locator overdenture, or full-arch bridge) and any preferred implant platform connections (Nobel, Straumann, BioHorizons).
• Relevant Medical Alerts: Note any anticoagulant medications (Coumadin, Eliquis, Plavix), antiresorptive/bisphosphonate therapy (Prolia, Fosamax), cardiac conditions, joint replacements, latex allergies, or extreme dental anxiety requiring conscious sedation.

Specialty Intake Triage Matrix

Collaborative Interdisciplinary Treatment Planning Protocols

Complex clinical conditions frequently involve intersecting biological domains that benefit from coordinated multi-specialty care before returning to your office for definitive restorative work:

• Combined Periodontic-Endodontic Lesions: In true perio-endo lesions where a deep periodontal pocket communicates directly with an apical radiolucency, proper treatment sequencing is essential. Our endodontic team performs microscopic endodontic disinfection and hermetic obturation first. After acute pulpal healing is confirmed, Dr. Walied Eldomiaty performs targeted LANAP laser therapy or guided tissue regeneration to repair the periodontal attachment apparatus.
• Pre-Orthodontic Gingival Biotype Augmentation: Orthodontic tooth movement through thin cortical bone or across deficient keratinized tissue can trigger severe buccal gingival dehiscence and root exposure. Dr. Eldomiaty provides connective tissue grafting and soft tissue biotype modification before or during active tooth movement, protecting periodontal architecture throughout orthodontic alignment.
• Terminal Dentition & Immediate Full-Arch Loading: When patients present with generalized failing dentition, our surgical team coordinates closely with referring restorative doctors. We utilize dual-scan radiographic templates to plan 3D computer-guided All-on-4 or All-on-6 reconstructions, verifying primary fixture stability with resonance frequency analysis (ISQ > 65) before immediate provisional conversion.
• Pediatric Dental Trauma & Apexogenesis: For fractured or traumatized immature permanent incisors in pediatric patients, our pediatric and endodontic clinical team coordinates vital pulp therapy (Cvek pulpotomy, MTA apexogenesis, or regenerative endodontic revascularization) to allow continued root lengthening and dentin wall thickening before referring back to your practice for aesthetic composite or ceramic restoration.

The ADSC "Treat & Return" Covenant

We want to reiterate our strict professional guarantee to all referring general dental colleagues: We perform only the specialized procedure requested. Upon completion of surgical or endodontic therapy and biological confirmation of stability, our office immediately transitions the patient back to your practice for all definitive restorative dentistry (crowns, bridges, implant restorations) and ongoing hygiene care. We do not provide or solicit routine general dental services to referred patients.

Frequently Asked Questions About Submitting Referrals