Referring Doctors

We look forward to being a resource to the community and improving the treatment outcomes of your patients with missing and/or damaged teeth issues.  

We believe that patients benefit when there is effective interprofessional communication.   To convey all appropriate information regarding your patient, we require use of our referral form.  Please submit it via Zirmed (our HIPPA-compliant, fully encrypted, web-based system) or just fax it to our office when scheduling your patient with us.  Click here to download and type directly into the form.  Our fax number is (435) 674-4345. In order to receive patient reports, we encourage you to register with Zirmed.  Simply send us your name, phone, email, fax, and NPI to us at and we will enter you in.  Then follow the steps below to exchange notes and attachments freely:

1. Go to:

2. Log in: using user name and password.

3. Click on "clinical link" tab.

4. Click on blue "create referral" tab.

5. Fill in the required fields including any notes.

6. Download and type in referral form and save as patients name.

7. Attach: referral form (see link to the left), radiographs, photographs, PDI checklists, etc...using the green "add" button.

8. Click submit.


Referral Form (can type directly into form)

PDI Checklist for Compromised Dentition

PDI Checklist for Partial Edentulism

PDI Checklist for Complete Edentulism