Provider Referral Form: Digital

If you are a provider looking to refer a patient to us, please fill out the patient referral form. We will reach out to your patient as soon as possible to schedule an appointment. Thank you for your trust in Southern California Center for Oral & Facial Surgery.

Patient Referral Form

Provider Referral Form: PDF

If you prefer to use a paper form, you can find the referral form linked below.

Please return the referral form to us by

  • Fax at: (818) 996-1325

  • Email at: office@sccofs.com

Provider Referral Form