These online referral tools are for the use of dentists or their staff to securely and electronically refer patients to Dr. Temlock’s office. Once submitted and received, Dr. Temlock’s staff will contact the patient directly to schedule an appointment.

Please fill in the applicable information below and hit the “Submit” icon. Basic patient and referring doctor’s information is required. Additionally, the referring dentist can electronically upload patient documents (x-rays, applicable dental and periodontal history, scan or picture of patient’s insurance cards, etc.) to ensure proper delivery to Dr. Temlock’s office.

Prefer a PDF Version?