Some of our clinics may require a referral from your outside provider. Your provider may request a secure email connection to send us these forms, FAX, or use the physical addresses noted below. Please consult our referral email policy before sending any patient information via regular email.

Oral surgeons with x-ray

Advanced General Dentistry (AGD)

AGD Referral Form (PDF)
FAX: 206-616-8545 | Phone: 206-685-8258

The Center for Pediatric Dentistry

Please have your dentist complete a referral form: Pediatric Dentistry Referral Form (PDF)

6222 NE 74th St.
Seattle, WA 98115
FAX: 206-543-0063 | Phone: 206-543-5800

DECOD Clinic

Please visit the DECOD Clinic pages for referral information
FAX: 206-221-5276 | Phone: 206-543-4619

Dental Urgent Care

FAX: 206-221-5276 | Phone: 206-543-5840

Faculty Practice

Faculty Practice Referral Form (PDF)

1959 NE Pacific Street D-453
Box 356365
Seattle, WA 98195
FAX: 206-616-8545 | Phone: 206-685-8258

Graduate Endodontics Clinic

Endodontic Referral Form (PDF) to be filled out by your dentist and emailed to the clinic with a recent periapical.

1959 NE Pacific Street, B-470
Seattle, WA 98195-7448
FAX: 206-616-9786 | Phone: 206-543-3995 | Email:

Northwest Center for Oral and Facial Surgery

Please have your dentist or physician complete a referral form: NWCOFS Referral Form (PDF)

Northwest Center for Oral and Facial Surgery
6222 NE 74th Street Box 354916
Seattle, WA 98115-4916
FAX: 206-616-7251 | Phone: 206-543-5860

Oral Surgery Student Clinic

Please have your dentist complete a referral form: Oral Surgery Student Clinic Referral Form (PDF)

1959 NE Pacific Street, D-251, Box 357134
Seattle, WA 98195-7134
FAX: 206-616-7251 | Phone: 206-685-3591

Oral Medicine Clinic/SCCA Oral Medicine Clinic

Oral Medicine Referral Form (PDF)

Oral Medicine Clinic: FAX: 206-616-8577 | Phone: 206-685-2937
Seattle Cancer Care Alliance: FAX: 206-288-1332 | Phone: 206-288-1333

Oral Pathology

Please contact our Oral Pathology Service

Oral Radiology Service

Please visit the Oral Radiology Services page as there are several options for radiographic images.

Graduate Orthodontics Clinic

Orthodontics Referral Form (PDF)

FAX: 206-543-5886 | Phone: 206-543-5787

Graduate Periodontics Clinic

Please have your dentist complete a referral form: Periodontics Referral Form (PDF)

1959 NE Pacific St., B-403, Box 357444
Seattle, WA 98195-7444
Phone: 206-543-5797

Graduate Prosthodontic Clinic

Please FAX a referral and cover letter.

1959 NE Pacific Street, Room B-469
Seattle, WA 98195
FAX: 206-543-7783 | Phone: 206-685-7522