To refer your patients for comprehensive orthodontic care: please provide as much information about your patient as possible so that we can provide the highest level of care. You can fill out the referral form below or print the form.

Click Here to Print a Referral Form

Patient Info
Patient Name*
First Last
Patient Email*
Patient Phone*
Patient Age*
Doctor / Dentist Info
Referring Doctor / Dentist*
Doctor / Dentist Phone*
Doctor / Dentist Email*
Reason for referral, treatment goals, comments
Periodontal Concerns
Periodontal
- No periodontal concerns
- Previous history of periodontitis, but not currently active
Specific Periodontal Concerns
Restorative & Cosmetic Concerns
All pre-orthodontic restorative treatment is complete
- Treatment Complete
Pre-orthodontic treatment yet to be completed:
Post-orthodontic restorative treatment proposed:
Patient Motivation
Patient's primary concern; In their own words:
Patient is primarily concerned with:
- Aesthetics
- Function
- Discomfort(TMD)
- Tooth Loss
Other Concern
Patient is:
- Highly Motivated
- Indifferent
- Discomfort(TMD)
- Apprehensive
TMD Concerns
Patient has signs or symptoms of TMD, including:
Oral Surgery Concerns
Please Describe Oral Surgery Concerns
Comments
This field is for validation purposes and should be left unchanged.

As one of the premier orthodontic practices in Dallas, TX our doctor and team at Face ForWard Orthodontics also provide 5-star orthodontic care to patients from Highland Park, University Park & Lakewood, TX, and Surrounding Areas.

Your Top-Rated & New Favorite Orthodontist in Dallas, TX!

"Very professional and knowleadgeable. Strongly recommended for every family orthodontics needs. Great staff as well!"

"Always a great experience. Staff are very professional and friendly."

"Our experience with Dr Ward and his staff is always so positive each and every time we go. My son really likes how personable and friendly everyone is. Love this place. We've only just had the Myobrace for the past year and the results have been amazing!"

"We love Dr. Darin and his staff. The atmosphere is so positive and energetic. My kids never complain about having to go to my daughter's appointments!"

"Dr. Darrin has a talented way of making something scary seem exciting!"

*The reviews listed are from actual patients of Face ForWard Orthodontics. Individual results may vary. Reviews are not claimed to represent results for everyone.