��Online Referral Form
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.
Thank you for considering Bala Institute of Oral Surgery to take care of your patient. We appreciate your confidence in our practice. To assist your patients and staff in the referral process, we ask that you please give your patients a filled out referral sheet with the details of what needs to be done – including tooth number(s). Please emphasize to your patients that they must bring the referral with them to our office. We will not be able to treat them without it. If, for some reason, the patient leaves without it, kindly fax over a copy of it for our records prior to or on their appointment date. Our fax number is (610) 617-9275.
To ensure proper communication, you will find a PDF file of the referral slip under the “Referral Forms” tab above. Should you need hard copies of our referral pads, please feel free to call us and we will be more than happy send some.
We take most insurances and can usually accommodate for emergencies.