We Accept Denti-Cal · Most PPO & HMO Plans Welcome
  1. Home
  2. Refer a Patient

Refer a Patient to Clark St Dental of Lakewood

Thank you for trusting us with your patients. Our team provides pediatric dentistry, orthodontics, sedation and oral surgery in-house, and we will keep you updated on your patient's care.

Book An Appointment Call (562) 573-2935
Before the visit

Instructions for Your Patient

  • A complete exam and x-rays will be taken at the first visit to confirm the diagnosis and plan treatment.
  • Patients referred for pediatric sedation should have nothing to eat or drink for 2 hours before the appointment.
  • Please ask your patient to bring their insurance card and photo ID.
Refer a patient at Clark St Dental of Lakewood
Online referral

Referral Form

  1. 1 Referral details
  2. 2 X-rays & files
Patient Information
Referring Doctor / Office
Tooth Chart (click to select)
Upper
Lower
Primary Upper
Primary Lower

No teeth selected

Services Requested
Patient Type