Orthodontist Gresham Sandy OR | Hardin Orthodontics

Refer A Patient

A successful practice doesn't just happen. It is the result of a strong commitment to excellence in our treatment and in our relationships with patients and doctors. We'd like to take a moment to thank you for showing your confidence in our practice by recommending us to your patients. We're gratified to find how many new patients regularly call on us based on your words of advice.

Doctor Referral Form

If you are a doctor who is referring a patient to us, please fill out and submit the following form.

Your Information:

Your Name:

First

Last
Your Practice Name:

Full Practice Name
Practice Email Address

Valid Email Address

Referral Information:

Name of Person You're Referring:

First

Last
Patient Email Address

Valid Email Address
Were Radiographs Sent?

Yes No

When were they sent?
Additional Information:

Comments:

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Verification Code: (case sensitive)

Refer A Patient

Your Name:

Your Practice Name:

Practice Email Address

Name of Person You're Referring:

Patient Email Address

Were Radiographs Sent?

Additional Information:

For Security Purposes, Please Enter the Code Below:

Dr. Tod M. Hardin | Gresham Office | 501 NE Hood Avenue, Suite 305 | Gresham, OR 97030 | p. (503) 666-2196 | f. (503) 492-8798Sandy Office | 37569 SE Hwy 26 | Sandy, OR 97055 | p. (503) 668-0320

Dr. Tod M. Hardin | Gresham Office | 501 NE Hood Avenue, Suite 305 | Gresham, OR 97030 | p. (503) 666-2196 | f. (503) 492-8798
Sandy Office | 37569 SE Hwy 26 | Sandy, OR 97055 | p. (503) 668-0320