Virginia Oral & Facial Surgery Online Patient Referral Form

At Virginia Oral & Facial Surgery, we value our relationships with referring dental practices and are proud to partner with you in providing excellent oral healthcare to our community.

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.

Please select the appropriate form from the menu below:

Brandermill Office

Monument Office

Mechanicsville Office

Sandston Office

Southside Office

West End Office

Please Note:

Our online forms use the Adobe Acrobat 5 Plugin. Please download the free plugin from Adobe’s web site if it is not already installed on your system. It is important that you have version 5 of the plugin, in order to successfully use our form.

To achieve a high level of trust with our shared patients, we:

  • Review cases thoroughly in advance
  • Refer back to your office for restorations
  • Collaborate with you on treatment plans
  • Are available in an advisory role if requested
  • Offer accommodating scheduling
  • Provide timely assessments and imaging

We have a selection of tools and resources assembled here such as our referral form and links to articles you may find interesting. If you have any questions about our practice, please call us at Brandermill Office Phone Number 804-608-3200.

Above all, we want to thank you for your referral of our office.