For Referring Dentists

Patient Referral

We make the referral process seamless and ensure your patients receive the highest level of specialty care. Submit a referral today and let’s work together to support your patients’ oral health.

Submit a referral

Fields marked with an asterisk are required. Additional options appear once you choose the type of referral.

USC Patient Referral

Nature of the referral

Check all that apply. Additional fields will appear for the options you select.

Prefer to print and fax?

Download the referral form, complete it, and fax it to whichever office is closest to your patient.

Louisville fax
502-899-9919

Elizabethtown fax
270-763-1390

New Albany fax
502-899-9919

Our three locations

Full addresses, office hours, and driving directions for each office.