Thank you for referring your patient to our office. We value our relationship with you and will strive to give your patient outstanding care.

To help make the appointment process go smoothly, we would appreciate a copy of any radiographs you may have taken, and a quick note about any treatment you may have rendered.

Eastshore Pediatric Dental Group Referral Form

Our contact information for sending the referral and/or radiographs is as follows:

Email: info@eastshorepdg.com
Fax: (510) 964-0908
Address: 2000 Appian Way, Ste 303, Pinole, CA, 94564

Feel free to call us with any questions or special concerns at (510) 964-0168.

Thank you!

Referral From

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Please use this form for general information purposes only. DO NOT send personal health information through this form. Specific patient care must be addressed during your appointment.

Please complete the following form to request an appointment. Please also note that availability will vary depending on your request. Your appointment will be confirmed by phone by a member of our staff. Thank you!
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