Get Uic Endodontics

This guide provides a comprehensive overview of how to fill out the Uic Endodontics referral form online. Follow the steps outlined below to ensure a smooth completion of the form, catering to various users' needs.

Follow the steps to complete the Uic Endodontics referral form online

1. Press the ‘Get Form’ button to access the referral form and open it for editing.
2. Enter the date of referral in the format: month/day/year.
3. Fill in the referring dentist's name and the name of their practice.
4. Provide the office telephone number and email address.
5. Enter the patient's full name and date of birth.
6. If the patient is a minor, include the name of their parent or guardian.
7. Input the patient's telephone number and email address.
8. Specify the tooth number or the area that requires attention.
9. Select the reason for referral by checking one of the given options.
10. Indicate the medical and dental history status of the patient.
11. Provide details regarding restorability and periodontal status as applicable.
12. Include any other comments or additional information as necessary.
13. Once all fields are completed, save changes, and download or print the form for submission.

Complete your Uic Endodontics referral form online today!