Patient Referral Forms
The College of Dentistry is proud of the partnership it shares with the Iowa dental community and appreciative of the referrals to our student and faculty clinics.
Specialists are conveniently available at the College for consultation or treatment in a variety of disciplines to help meet the dental health care needs of your patients. These areas include: prosthodontics, periodontics, oral and maxillofacial surgery, endodontics, oral pathology, preventive dentistry, restorative and cosmetic dentistry, pediatric dentistry, dental care for the special needs of the elderly, and dental care for mentally, physically, and medically complex patients.
It is our hope that the available referral forms will assist in the co-treatment of your patients when the need arises. Your continued support helps to educate the next generation of Iowa dental practitioners.
Forms for Referring to Specialty Clinics at the College
- Referral to Endodontics - Electronic or Printable
- Referral to Implant Screening Clinic - Electronic or Printable
- Referral to Operative Dentistry - Electronic or Printable
- Referral to Oral & Maxillofacial Surgery
- Referral to Hawkeye Oral Surgery
- Referral to Oral Pathology, Radiology & Medicine
- Referral to Orthodontics
- Referral to Pediatric Dentistry - Electronic or Printable
- Referral to Periodontics - Electronic or Printable
- Referral to Prosthodontics - Electronic or Printable
- Referral to Geriatrics and Special Needs / Preventive & Community Dentistry - Electronic or Printable
- Referral to Temporomandibular Disorder and Orofacial Pain - Electronic or Printable
Forms for Referring to Faculty General Dentists at the College
Use one of the forms below ONLY if you are referring a patient to be seen by a faculty general dentist at faculty fees. If your patient wishes to be treated in the student clinics at reduced fees have the patient call 319-335-7499 for more information and to make a screening appointment or click here for an information sheet on the student clinics.
Form for Referring to Hospital Dentistry Institute
Use one of the forms below ONLY if you are referring a patient to be seen at the Hospital Dentistry Institute.
Upload Patient Images, Radiographs, Photos, Notes
The University of Iowa Dental School & Dental Clinics has subscribed to eDossea to securely, quickly and completely receive all the required patient information from you. eDossea is HIPAA compliant and specifically designed for dental professionals to securely exchange electronic records. The images you send will arrive undistorted and the patient information will be complete. There will be an exact record of what was sent stored in our secure eDossea account. If needed, we will be able to quickly send patient images/records back to you. There is no charge to you for using this system.
For assistance please contact:
The University of Iowa College of Dentistry & Dental Clinics Central Records (319-335-7429)