Referral Form


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.

Once you have submitted the form, you will have the opportunity to securely upload and transmit images of patient x-rays. Please call us for assistance: Wheat Ridge 720-583-0523 or Dacono 720-990-5544.

Premier Provider
Dacono Office

Front Range Oral Surgery
4943 Highway 52, Suite 260
Dacono, CO 80514

Map & Directions

Phone: 720-990-5544
Fax: 720-583-0526

Wheat Ridge Office

Front Range Oral Surgery
10160 W 50th Ave, Unit 1
Wheat Ridge, CO 80033

Map & Directions

Phone: 720-583-0523
Fax: 720-583-0526

Comfortable, Compassionate Oral Health Care for All Ages

Balance, Comfort & Function!