Patient Referral

Thank you for considering East Tennessee Oral and Maxillofacial Surgery for your patients’ surgical needs. You are welcome to fill out the form on this page to quickly get your patient into our system or print out the pdf, complete it and send it along with your patient. We have included maps to each of our seven locations on the second page of the pdf for your patient’s convenience.

If you have questions please call us at any time.

etoms referral form

Patient Referral

Please fill the form