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Fill The Referral Form

3901 Dutchman’s Lane, Suite 201 Louisville, KY
Phone (502) 268-4840
advancedimplantcenters.com

Doctor-Patient Info:

Appointment Information: This time is reserved specifically for you. If, by necessity, you must reschedule your appointment for surgery, please notify us at least one day in advance.

For Implant Referrals

Robert Schroering, DMD

Diplomate, American Board of Oral Implantology, Advancement of Dental Education & American Academy of Implant Dentistry

Special Instructions for General Anesthesia Patients:

Patients who receive general anesthesia should not have ANY FOOD OR DRINK, including water, for at least 6 hours prior to surgery.

You must arrange for someone to drive you home after surgery. Your driver must come into the office to pick you up.

Please bring this referral with you to your appointment.

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Implant Evaluation For:

Has the patient received quadrant scaling and root planing?

X-RAYS:

Does the patient have a recent FMX you can provide us?