New patients - Cook Periodontics
New Patient Referrals
You may refer patients to our office by filling out our secure online Referral Form. After you have completed the form,
please make sure to press the Submit button at the bottom to automatically send us your information.
Along with a detailed referral form, please upload all x-rays taken in your office within the last 3 years. If you have difficulties submitting them via the website, you may email them to email@example.com. Patients with no current
x-rays will have them taken in our office at their first visit.
Once you have submitted the form there is an option to download and print a completed copy for the patient.
If you need assistance with our online system, or questions about a new patient referral please contact our New Patient Coordinator at 910-256-8486 option 1.
We look forward to working with you and your patients!