Doctor Referrals

At Coastal Periodontics, we greatly value our relationships with general dentists, specialists, and healthcare providers throughout the Seacoast region. Our goal is to provide seamless communication and collaborative care to ensure the very best outcomes for every patient you entrust to us.

Referral Process

Download Doctor Referral Form

Please use the referral form below for all patient referrals.

How to Send a Referral

1. Download and complete the referral form – Fill in the patient’s information, treatment needs, and any relevant medical or dental history.
2. Send the completed form – Email or fax the referral form directly to our office:
   1. Email: info@coastalperiosurgery.com
   2. Fax: (603) 501-0595
3. Include supporting records – Please include a full mouth series of radiographs along with the most recent x-rays available.

Our team will promptly contact your patient to schedule their appointment and will keep you updated throughout their treatment.