Referral To Periodontist For Grafting

Dr. Name
Office address
City, State ZIP
(or preferably print on letterhead)


Dr. Periodontist
City, State  Zip

Dear Dr. Periodontist:

I have referred [patient name] to you for grafting evaluation.  Full Mouth X-rays taken today are enclosed; please return.

Laura has numerous areas of recession, and lack of attached gingiva; particularly 22, 28 areas.  Please evaluate all areas, and treat as needed.

XXXX is 21 years old.  She might be losing coverage on her parents insurance soon.  Very nice family.



Dr. _____