DANIEL GARRISON, DMD, ABO

RIVER RIDGE ORTHODONTICS®

To which office are you referring this patient?

Patient's First Name:
Last Name:
Age:
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Home Phone:
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Other Phone:
Patient's / Parent's chief complaint:
Enter tooth number(s):  
Enter tooth number(s):  
Other:
Comments:
Are you sending a Panoramic X-ray? Dated:

Please email the panoramic x-ray to drgarrison2@riverridgeortho.com ATTN: Taletha.

Thank you for entrusting your patient to our care.

Please let your patient know that we will be sending paperwork prior to their complimentary consultation.

We will do our best to make them feel welcome at our office.

We will send you a summary of our findings and recommendations immediately after the consultation.

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