3D Oral & Maxillofacial

Imaging Center, LLC

COMFORT

LOW RADIATION

TREATMENT

BETTER OUTCOMES

DIAGNOSIS

ACCURACY

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Referral Form can be printed or saved to your file.   We can also send you a referral pad by mail. Completed form must be signed by the referring doctor.  We prefer the form to be faxed to us at 240-560-5358 prior to your patient's imaging appointment.

REFERRAL FORM