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Oral and Maxillofacial Surgery Referral Form University of Illinois at Chicago College of Dentistry Oral Surgery Fax 312 -996-5987 email oralsurgery uic.edu If emergency please call Dental Urgent Care at 312 -996-8636 Date of referral Referred by Office phone/email/fax Patient name/parent for minors Patient phone Patient email Patient INSURANCE information Dentoalveolar surgery Extraction teeth s Please mark teeth to be extracted on diagram Alveoplasty Incision and drainage Apicoectomy Biopsy Expose and bond Frenectomy Dental implants Pathology/Biopsy Orthognathic evaluation TMJ evaluation Cosmetic facial surgery Radiographs Attached to this referral Will send by email oralsurgery uic.edu None available Medical History Negative Significant Special needs Anesthesia Recommendations Local anesthesia IV sedation General anesthesia operating room Indicate facial injury swelling or other findings Other/Comments Person completing this form Signature initials Phone Fax email Note UIC Missed Ap....

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There are three common types of dental implants that you can choose from Endosteal, subperiosteal, and zygomatic. Endosteal is the safest and most common, followed by subperiosteal, and then zygomatic being the last and most complex.

Here are some common methods that patients use to afford dental implant procedure, most not requiring high credit scores. Healthcare installment plan. Dental insurance plan. Flexible Spending Account / Health Savings Account. Join a dental membership savings plan. Home equity line of credit. Retirement plan loan.

We treat a wide variety of dental care needs, from simple tooth decay repair and single implants to the most complex reconstructions and full mouth prosthesis. Restoring smiles– returning optimal esthetics and function to teeth — is a distinction we value.

Single Tooth Information When you need a single dental implant, it can cost between $1,000 and $3,000, but the abutment and the crown can add another $500 to $3,000. This addition makes the total between $1,500 and $6,000. This base rate is the average amount out-of-pocket.

Welcome to UIC College of Dentistry Heading link Copy link DMD, PhD and Advanced Specialty Training programs to prepare the next generation of oral health professionals.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232