little smiles
New Patient Referral

  • If you are a healthcare provider and would like to refer a pediatric patient to Little Smiles for dental treatment, please complete the new patient refferal form below. When you submit this form, an e-mail will automatically be sent to the patient's parent/guardian with instructions for scheduling their appointment at Little Smiles.

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  • NOTE: As a standard procedure, Little Smiles will take new films during the patient's first appointment. It is not necessary to send or attach any existing films. On behalf of the Little Smiles team, we thank you for your referral and trust.

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