Referral Forms

The Patient Referral Form is to be completed by referring dentists/doctors.

Click on the link below to complete the Patient Referral Form. The form can be completed online and can be printed and given to the patient, faxed to our office at (919) 787-7634 or emailed directly to royegainesjr@bellsouth.net.

“Evidence-based Management of Third Molar Teeth” has been developed by the AAOMS as a clinical slide presentation for fellows and members to download and use in educational situations to help health care professionals better understand the evidence-based management and treatment of third molar teeth.

Patient Referral form (PDF)

Evidence-Based Management of Third Molar Teeth