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Thank you for choosing Children & Teen Dental.

We are committed to providing excellent service and care to you and your patients. We are fortunate to maintain strong relationships with other physicians in our area, and our mutual referral process is instrumental in connecting us with patients in need.

Referring Physician Liaison

Our liaison is available to answer your questions about appointment scheduling, our physicians and services, education seminars, or other concerns. She can also schedule a meeting to introduce our physicians to your staff.

Contact our Referring Physician Liaison at 205-758-3341

Thank you for trusting your patient’s care to us.
Children & Teen Dental 

 
Referring Physician Information
Referring Physician Name *
Referring Physician Name
Phone Number *
Phone Number
Address *
Address
Patient Information
Patient Name *
Patient Name
Parent or Guardian Name *
Parent or Guardian Name
Phone *
Phone
Address *
Address
Referral Information
Urgency
Type

We are providing this Contact Us form as a convenience but your message to us should not imply the creation of a doctor-patient relationship (which only happens when you come to our office for a visit). We therefore ask that you not include personal health information in your message. Please call us if you’d like to send us personal information so that we can make sure it’s handled securely.