Referral Forms
The following forms can be used for a variety of referral needs. Please follow the specific directions listed within each referral form for how to submit the information.
Follow the referral form's specific directions for how to submit referrals. For questions, please contact the clinic directly.
Referral Required
Endodontics (Root canals)
Geriatric and Oncology Dentistry
- Email dentaloncology@osu.edu or fax 614-292-8244
Ohio State Dental Faculty Practice
Ohio State Upper Arlington Dentistry (off-campus)
Oral and Maxillofacial Imaging
Oral and Maxillofacial Surgery
We have changed our referral process. Our process is now an online submission for your referral to Oral and Maxillofacial Surgery.
Once the referral is submitted, email imaging to OMFSrecords@osu.edu. Imaging must include the patient’s full name, date of birth, and date of imaging. Please discontinue using our previous referral form. We will not accept faxed referrals. The referring physician will be notified directly (preferred email address) for any referral we cannot accept. Our office staff will contact your patient if the referral is accepted.
Periodontology
- Referral form
- Please email radiographs and the Graduate Periodontology Referral Form to PeriodonticsClinic@osu.edu.
Prosthodontics
If you require assistance with these forms, please contact our webmaster.