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Referral Forms for Health Care Providers - Dr. K's Pediatric Dentistry in Palmer, AK

Dr. K's Pediatric Dentistry welcomes and values other health care providers consultation requests and referrals.  Upon examination of the patient, referral sources will receive a report of findings, recommendations, and/or any treatment performed. You may refer patients to our office by filling out the referral form below and sending it along with the patient, faxing it to our office at (907) 745-5457, or emailing it to us at  Thank you!

Click on the link below to download (PDF) and print.

Dr. K's Pediatric Dentistry Referral Form

Dr. K's Pediatric Dentistry
125 W. Evergreen Ave. Ste 204 Palmer, AK 99645
Phone: (907) 745-5437 URL of Map