Referral To Pedodontist

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

October 4, 2006

Dr.  Pedodontist
City, State  Zip

Dear Dr. Pedodontist:

I have referred [child's name] to you for comprehensive treatment.

Angel was new to us today.  She is 6 years old.  At her last dental office (Dr. ____) she had a prophy on 5/25/2011, and bitewings.  We don’t have any copies of these.

We took two bitewing x-rays today, and gave Mom a set to take to you.

Our findings:

  • Caries A, B, I, J, K, S, T; possibly more areas
  • Angel reports occasional pain in S-T area
  • Unsealed 3, 14, 19, 30
  • Moderate crowding

Thank you for taking good care of Angel!



Dr. _____