Thank you for your referrals!
We promise to provide excellent care for all of your patients!
You may refer patients to our office by filling out our secure online Referral Form below. After you have completed the form, please make sure to press the Complete and Send button at the bottom to automatically send us your information. You may also download/print our classic paper referral form below. The security and privacy of patient data is one of our primary concerns, and we have taken every precaution to protect it.
Please make sure when sending email correspondence to include the patient’s full name and any nickname spelled accurately along with the date the imaging was taken. If the x-ray will be sent with the patient, please note this on the referral form. Thank you!
We are happy to accommodate any same-day dental emergency patients you refer over.
When you call our office to request a same day emergency procedure (Cons-Do) for your patient with Dr. Catalano, please be prepared to answer the following questions when you call. This will ensure your patient has the best possible experience during their procedure. This Questionnaire is available for download and print below.
1. Is the patient in pain or swollen?
2. Is the patient currently taking any Anticoagulants (bloodthinners)?
- Heparin(Fragmin, lnnohep & Lovenox)
- Warfarin(Coumadin, Jantoven)
If so, when/what was their last dose taken?
3. Does the patient need to pre medicate or have they pre-medicated already today, and if so, when?
4. Is the patient interested in oral sedation today? (ie. valium) If so, what are their drug allergies?
5. Is the patient interested in having a possible future dental implant placed in the area of the extraction?
Online Referral Form
and completely secure
Doctor Referral Slip
Print and email slip to firstname.lastname@example.org and make sure to include any corresponding x-raysClick Here to Print
If you are calling us from a provider’s office to request a same day, or emergency visit for your patient, please have these answers ready prior to calling. Thank you!Click Here to Print