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Referring Doctors

Online Referral Form

If you are a referring dentist, please use the secure online referral submission form by clicking the button above. This form is part of a HIPAA-compliant platform designed to protect patient privacy and ensure the safe transmission of sensitive information. We appreciate your referral and look forward to providing your patient with excellent care.

*Additional Terms and Conditions for Extraction Promo:

  • Valid for uninsured patients only.

  • Limited examination is problem focused only and not comprehensive.

  • X-rays may include panoramic radiograph and/or periapical/bitewing radiographs.

  • Certain teeth, primarily impacted wisdom teeth, may be subject to a higher cost. 

  • No guarantee of treatment. Treatment completion is based on a number of factors including, but not limited to, medical history, presence of pathology, and/or high risk extractions.

  • Promotion does not include any sedation services or other surgical services such as bone grafting. 

  • Payment due at time of service and subject to financial agreement. 

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19720 68TH AVE W STE C

Lynnwood, WA 98036

referrals@nwslog.com

P: (425) 245-8295
F: (425) 245-8394

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