Call or text:

Dallas (972) 666-5363

Garland (972) 544-0032

Home
New Patients
What Sets Us Apart Team Orthodontics Financial-Insurance Info Your First Visit Office Tour Patient Registration
Orthodontics
Smile Gallery Orthodontic Services Cost of Braces Orthodontic FAQs Digital Lab
Contact
BookOnline!Referral

Referral Book Online!

Referral Form

Dr. Hessam Rahimi name an credentials

Referring Doctor

Office Name:

Patient Information

Patient Name:

Dentist Name:

Cell Phone (Email):

Office Phone (Website):

Date of Birth:

Referring Doctor

Orthodontic Evaluation (Comprehensive, Phase I)

Orthognathic Surgical Evaluation

Limited Pre-Prosthetic | Pre-Implant Orthodontic Evaluation

CBCT 3D X-ray (i-CAT^TM)

Intraoral 3D Scan (iTero^®)

Referring Doctor

Conventional Braces

Clear Braces

Aligners (Invisalign^®)

Brava™ by BRIUS™

Comments:

Please choose the office location you’d like to refer to.

Thank you

Thanks for reaching out. We will get back to you soon.

Oops! Something went wrong while submitting the form.

Technologies

Brava Invisalign Traditional Braces Digital Lab

Follow Us

Brava by BRIUS, Braces and Invisalign Provider, Dallas and Garland TX | Fusion Orthodontics | © 2024. All rights reserved.

Powered by Vortreks