WisNova | Referrals

This site works best with Javascript enabled.

Services
Our Practice
Surgical Information
Referrals
News
Contact

Office Referrals

Patient Information

download pdf

Please leave this field empty.

Patient will receive an email confirmation of this referral.

Referring Doctor Information

You will receive an email confirmation of this referral for your records.

Oral Surgery

Dental Implant Soft Tissue / Bone Grafting Third Molars Extractions (see tooth chart below) Oral Pathology - Biopsy Preprosthetic / Alveoloplasty Orthognathic / Sleep Apnea Oral & Facial Trauma Infection / Incision & Drainage Exposure & Bonding

Endodontics

Endodontic Consultation CT Imaging Non-Surgical Endodontic Treatment Surgical Endodontic Treatment Endodontic Retreatment Post Space Close Access

Periodontics

Dental Implant LANAP / Laser Perio Crown Lengthening Soft Tissue / Bone Grafting Periodontal Evaluation

Upload X-Ray Images

remove

Add File

Anesthesia

Patients requiring General Anesthetic or I.V. Sedation are seen for consultation prior to procedure

Local Anesthetic I.V. Sedation Nitrous Oxide

Surgical Template

Extractions Teeth 1

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

R L

32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17

< >

Extractions Teeth 2

A B C D E F G H I J

R L

T S R Q P O N M L K

< >

Doctor's Notes

“I truly enjoyed my visits and am sorry to see the end. How many oral surgeons have patients who can comment as such?”

Nancy G., Kenosha

Services
Surgical Information
Our Practice
Referrals
News
Contact

Official Oral Surgeons of:

WisNova Institute of Dental Specialists • CARE CREDIT • Privacy Policy