Online Referral Form
Galleria Oral & Maxillofacial Surgery – Roseville CA
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 Complete and Send button at the bottom to automatically send us your information. The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it.
Please download a copy of our Printable Referral Form and send it with the patient, and feel free to fax it directly to our office at (916) 783-2111. We are happy to contact the patient and get them scheduled a timely manner.
If your patient is enrolled in an HMO insurance plan, an HMO specific referral form must be sent to our office as well. We appreciate your cooperation in this matter, so we can guarantee all patients a pleasant experience in our office.
We are happy to waive our panoramic x-ray fee to any patient who is sent with an x-ray (Panoramic or PA) which was taken within the last six months.
We try our best to stay on schedule to minimize patients waiting. Due to the fact Dr. Antipov provides many types of dental services, various circumstances may lengthen the time allocated for a procedure. Emergency cases can alsoarise and cause delays. We appreciate your understanding and patience.