Patient Referrals

We gladly welcome patient referrals.

Here are the 3 ways to refer a patient to our office:

1. Fill out an Online Referral Form

You will find the online referral form below on this page. Fill out all the required sections, & we will contact the patient once we receive the referral. Remember: The more information, the better.

2. Print & Fill out a Paper Referral Form

Print a paper copy of the referral form, & fill out all the necessary information. Advise the patient contact us to schedule an appointment. Please remind the patient to bring the referral form to our office.

Paper Referral Form
Paper Referral Form

3. Contact our office

When in doubt, just reach us directly.

Contact Us
Contact Us

For emails with sensitive patient information, please click on the button to the right —>

Encrypted Email
Encrypted Email

1. Fill out an Online Referral Form

Please fill the online referral form below.

If your office would like a physical referral pad with business cards, please contact us at (713) 270-7626.

2. Print & Fill out a Paper Referral Form

Referral form for Maxillofacial Prosthodontist Dr. Diana Pham from Houston, Texas
Referral form for Maxillofacial Prosthodontist Dr. Diana Pham from Houston, Texas
Click here to download & print our referral form
Click here to download & print our referral form

Schedule an appointment with us.

Hours
Monday, Tuesday, Thursday
9:00 AM - 3:30 PM

Friday

9:00 AM - 2:00 PM

Closed Wednesday, Saturday, & Sunday

By Appointment Only

Phone
(713) 270-7626

Fax
(346) 327-7783

Location
7718 Bellaire Blvd,

Houston, TX 77036