Patient
Referral Program



Thank you for visiting our website and for your continued referrals. We recognize how valuable communication is between our practices and want to ensure it continues.

To practices referring patients to The Perio Pocket, please submit the below Referral Form with your patient's information. 

Alternatively, if you do not wish to use the online form submission, please download the PDF form from the link, below, and email it to us at office@theperiopocket.com


Online Referral Form

The Perio Pocket welcomes periodontic referrals for private treatment. With our highly skilled and experienced team, we can accept referrals for management of aggressive periodontists, chronic periodontists, or cases where patients are not responding to treatment. Our specialist periodontist and dental hygienist have experience with treating gum disease.







    Radiographs taken or included with referral



    Why
    Choose Us?

    We are committed to patient care by providing you the best service possible in the areas of periodontics, dental implants, and oral medicine.

    From family periodontal maintenance to dental implants, we offer your entire family comprehensive dental care that’s second to none.

     

    Ready for Treatment?
    Restore Your Smile!


    We look forward to hearing from you. Please call our office at (619) 643-5081 or send us a message to request an appointment.