Oral Surgery Referral Form

If you wish to refer a patient to our office, please use our Referral Form below.

Glendora Oral Surgery Online Referral form

Technical Note:

Our online referral form uses Adobe Acrobat Reader to conveniently print the form from home or work. Please download the free plug-in from Adobe’s web site if it is not already installed on your system.


Please contact the office with any questions or concerns.

Glendora Office Phone Number 626-914-4587 Email Us

Our office is located at: 410 S. Glendora Avenue, Suite 220, Glendora, CA. 91741

Office Hours

Monday:   8:00 AM - 4:30 PM
Tuesday:   8:00 AM - 4:30 PM
Wednesday:   8:00 AM - 4:30 PM
Thursday:   8:00 AM - 4:30 PM
Friday:   8:00 AM - 4:30 PM