Referral Form

Refer Patients Online

You may refer endodontic patients to our office by using our online Doctor Referral portal or form. If you have any questions or need assistance, please call our office: Blanco Office Phone Number 210-341-8281.

Office Hours

Monday:   7:15 AM - 5:00 PM
Tuesday:   7:15 AM - 5:00 PM
Wednesday:   7:15 AM - 5:00 PM
Thursday:   7:15 AM - 5:00 PM
Friday:   7:15 AM - 5:00 PM
Saturday:   Closed
Sunday:   Closed


Use the Referral Form button below to view the form.

Online Referral Portal


You may also download and print a Referral form. Once completed, you may either give it to the patient or fax to our office at 210-341-8282.

Patient Referral Form

Technical Note

The Referral form is in PDF format. If you do not have Adobe Reader installed on your computer, you may download Acrobat Reader for free and use it to access these forms.