Referrals - Sahouria Pediatric Dentistry & Orthodontics

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Refer Dr. Jamie Sahouria

Introducing Patient *

Date of Birth

Parent Name *

Parent Phone *

Reason for Referral

Child is in pain

Child is frightened/uncooperative

May need sedation or general anesthesia

Completed cleaning & flouride treatment

X-rays have already, or will be emailed

No x-rays taken

Remarks

Referring Doctor *

Phone

Email *

Upload X-ray, Picture, or Digital attachment

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Jamie J. Sahouria, D.D.S., M.S.

Diplomate of the American Board
of Pediatric Dentistry

Friendly & experienced team
Paperless “Green” Office
Latex-free environment
Digital X-rays & CBCT 3D X-rays
State-of –the-art sterilization
White crowns & fillings
Laser Lip & Tongue Tie Revision (Frenectomy)
Braces (Orthodontics) & Adult Dentistry available in our building
Minimally invasive options (Silver Diamine Fluoride)
Nitrous oxide (laughing gas), conscious sedation & general anesthesia
Before & after school appointments
Financing plans available
Accept most PPO insurances
Handicapped accessibility
Emergency care
Emergency after hours on call (active patients)
Annual Back to School Carnival & Chalk Off benefiting local schools
And much more!

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© Sahouria Pediatric Dentistry & Orthodontics 1303 Medical Center Drive Rohnert Park, CA 94928

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