Patient Referral Forms:
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.
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.
Please complete the referral form.
After completed, you may print a copy to give to the patient and/or for your records.
Please click the submit form button. The referral will now be sent securely to Oral Surgery Associates of Eau Claire.
You will now be directed to a location where you can upload the x-rays from your computer.
At this point, you will click on the browse button and locate the appropriate patient’s x-ray. Double click on the x-ray you wish to attach.
Click the upload button. Your x-rays will then be sent to Oral Surgery Associates of Eau Claire securely.