Patient Referral

Referral Form & Insurance

We accept all major preferred provider organiztion (PPO) dental insurance as well as all flexible and health savings account (FSA/HSA). Please contact our office and one of our insurance and billing specialist can help you navigate through all the requirements and pre-authorizations, if necessary. If you are being referred to us from your dentist, please be sure to have them fill out a referral form from above.

Dental Insurance

Most major PPO dental insurance are accepted.  Please call for details.

Flexible Savings Account / Health Savings Account

All of your treatment and dental therapy can be paid by cash, check, or approved Flexible and Health Savings Account.

Patient Referral Form

Caring for You

Providing unparalleled patient care and is our number one priority. Below you will find a computer-fillable patient referral form for your convenience. We accept all major dental insurance and FSA. Please contact us if you do not see your insurance listed above.


Consult with your referring dentist to complete this form.


Call Us

(281) 531-9900

Physical Address

1809 Eldridge Parkway, Suite 200 Houston, Texas 77077


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