Referring Dentists Mt. Vernon

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Thank you for taking the time to refer a patient to Wigal Orthodontics in Heath or Mt. Vernon. Please take a moment to fill out the form below. A member of our team will be in contact with your patient as soon as possible. If you have any questions about our practice or the services we offer, don’t hesitate to give us a call.

Referring Doctor's Name

Patient's Name

Patient's Email

Patient's Phone

Reasons for Referral Evaluate for interceptive treatment Evaluate for orthodontics Evaluate for orthodontic surgery Pre-prosthetic treatment needed Other Special Requests Please call before treating Radiographs have been sent after seeing patient Recent panoramic x-ray was taken More Information Select Location * X-rays can be sent to info@wigalorthodontics.com for Heath, OH location and office@wigalorthodontics.com for the Mt. Vernon, OH location.