Referral Form

Thank you for trusting our team to provide quality care to your patients. At Holden Periodontics & Dental Implants, we take pride in providing excellent care and streamlined communication at every step.

Please complete the referral form below with your patient’s information and your referral details. If you prefer, detailed and standard referral form links are below.

Once received, we will contact your patient promptly and update your office throughout their treatment.

Please email X-rays or CBCTs to [email protected] or call Holden Periodontics & Dental Implants Phone Number 803 291 0880. If you would like referral pads from our office please contact our office by email or phone, or download them here:

Referral Form

Please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to confirm your appointment. If you are an existing patient, this contact form should not be utilized for communicating private health information.

Privacy Policy

Patient's Name(Required)

First Last

Patient's E-mail Address

Patient's Phone Number(Required)

Patient's Date of Birth(Required)

Referring Doctor(Required)

First Last

Referring Doctor's Phone Number(Required)

Reasons for Referral(Required)

Message (Optional)

Initials

This field is for validation purposes and should be left unchanged.

Referring Doctors

Referral Form

Request An Appointment

Call 803 291 0880

Holden Periodontics & Dental Implants

5080 Sunset Boulevard, Suite A

Lexington, SC 29072

Tel: 803 291 0880

Fax: 803 262 2804

Serving [CITY] and the Surrounding Area Including
Lexington SC • Columbia SC • Cayce SC • West Columbia SC • Irmo SC
Forest Acres SC • Chapin SC

Holden Periodontics & Dental Implants
5080 Sunset Boulevard, Suite A
Lexington, SC 29072
803 291 0880

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Referral Form

Referral Form

Holden Periodontics & Dental Implants, LLC

Periodontal Treatments