Bloomington Pediatric Dentistry welcomes and values your referrals and we sincerely thank you for choosing our office! You may refer patients to our office by filling out the referral form and faxing it to our office at 812-355-0858. If your office needs to send us digital radiographs please email those to firstname.lastname@example.org including the patient’s name, date radiographs were taken, and if the patient has an appointment scheduled with our office. We want to ensure we have all of the information necessary when your patient arrives for their appointment!
As always, you may also call our office to schedule your patient if that is more convenient for you. Faxing the referral is just another way to ensure we receive all of the information about your patient. Please inform the parent/guardian that our new patient paperwork is now available to print off from our website on the appointment preparation page. You may also want to let the parent/guardian know that they can visit our Office Tour page so that the child can become familiar with what our office and staff looks like! If you or the parent/guardian have any questions please call our office and speak with one of our patient care coordinators.
Please fill out and fax to 812-355-0858
Please including the patient’s name, date radiographs were taken, and if the patient has an appointment scheduled with our office.
We understand that sometimes it's just easier to make a phone call.