Patient Referral If you have a patient for whom you’d like to make a referral to Gary D. Krueger, D.D.S., APC, please fill and submit the form below with information about your patient. Privacy Policy Patient* Home Phone # Work Phone # Appointment Date Referred By For Complete Dentures Removable Partial Dentures Prosthetic Reconstruction Following Head and Neck Surgery Facial Prosthesis Oral Sleep Apnea / Snoring Appliance Implant Reconstruction Crown and Bridge Prosthodontics Oral Evaluation for Radiation Therapy TMD/TMJ EvaluationX-rays Mailed Given to Patient Please TakeStudy Casts Given to Patient Not TakenMedical Alert Remarks or Special Instructions Referral by Fax Print, complete and fax the “Patient Referral Form” below to us.Fax: (760) 479-0963. Patient Referral Form (PDF)
