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Ariel J. Raigrodski, DMD, MS, FACP
Call (425) 771-2022
Lynnwood, Washington
Lynnwood, WA



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Referral Form

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Patient Information

Patient Name: *

Street Address: *

City: *

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Zip Code: *

 

Phone: (home) *

Work:

Cell:

 

Referred By: *

Office Email: *

Nature of Examination

Comprehensive

Implants

Removable Prosthodontics

 

Occlusion

Aesthetics

Fixed Prosthodontics

 

Treatment Suggested:

X-rays you will be sending:

FMX

BWX

PAN

PAX

CT SCAN

 

Comments:

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Treatment rendered:

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Like you, we are committed to excellence in patient care.
Unless otherwise directed, we will be happy to contact and make arrangements for your patient's appointment.

 
 

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We are your dental home for comprehensive care in a nurturing environment.
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Building relationships through trust and quality care.



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Ariel Raigrodski, DMD, MS, FACP
On-call evenings and weekends.

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19020 33rd Ave W Suite 200
Lynnwood, WA 98036
Call (425) 771-2022


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