Referring Dentists

First, We would like to thank you for your continued support. We value our professional relationship and are excited to continue to work with you.

You may refer patients to our office by filling out our secure online Referral Form. After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information. The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it.

(If you prefer paper referral forms, please let our office know and we will get those to you.)

Referral Form

Patient's Name:

Patient's Phone:

Dentist's Name:

Reason For Referral:

Other Comments:



File Downloads:
Referral Form

Dr. Alford has practiced Periodontics and Implant Dentistry for over 30 years serving patients throughout North Georgia, including Rome, Adairsville, Calhoun and Cartersville.
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