Referral Form for Dentists

Scott A. Reef, DDS, MSD and Justin J. Villanueva, DMD, MSD, DHL – Periodontal Associates of Lafayette

You may refer patients to our office by filling out our secure online here.

Referral Form

After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it.