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Get University of Illinois at Chicago Oral and Maxillofacial Surgery Referral Form 2014-2024

: ____________________________ Pathology/Biopsy:_____________________________ Orthognathic evaluation: ______________________ TMJ evaluation: _____________________________ Cosmetic facial surgery: _______________________ Radiographs:  Attached to this referral  Will send by email (oralsurgery@uic.edu)  Will send by US mail  None available Medical History:  Negative  Significant: _________________________  Special needs: _______________________ Anesthesia Recommendations: .

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