Referring Doctors in Glenview, Illinois

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We welcome doctor referrals at Prime Dental Specialists and value the trust you place in our team. Dr. Samantha Chou, Dr. Devin Roberts and Dr. Maryam Gheisarifar collaborate with referring providers to ensure patients receive detailed, high-quality care. Our prosthodontist and team in Glenview, Illinois, use a patient-first approach and modern technology to deliver precise treatment outcomes. For referral coordination or questions, please call 847-748-0061.

Referring Doctor Form

Referring Doctor:
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Patient Name: First
Patient Name: Last
 
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Reason for Referral:
Consultation regarding:
Tooth Chart:
(Please mark teeth for extraction/implant)
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Radiographs
To diagnose and treatment plan patients thoroughly, a full mouth (FMX) set of radiographs are required.
Digital Radiograph attached*(JPG, No Bitewings)
Please take Pano or CT Scan
*Click the "Choose File" button below to attach your files.
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