Referral Forms

RANDALL R. GORDON, DDS, MS

 

PERIODONTICS &

DENTAL IMPLANTS

 

1420 South Mills Avenue, Suite G, Lodi, CA 95242

Phone: 209.367.1484  Fax:  209.366.0998

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Randall R. Gordon, DDS, MS  - Practice Limited to Periodontics and Dental Implants

1420 S. Mills Ave., Ste. G, Lodi, CA 95242 • Phone: (209) 367-1484 • Fax: (209) 366-0998

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Referring Doctors

Referral Forms

Once filled out, please fax or mail the form and any applicable x-rays to either office location at:

Lodi Office:

1420 S. Mills Ave., Suite. G

Lodi, CA 95242

Phone: (209) 367-1484

Fax: (209) 367-0998

 

 

Email:

xrays@gordonperioimplants.com

The referral form is a PDF file and you must have Acrobat Reader installed on your computer to view it. If you do not have Acrobat Reader please click here to download a free copy.