Referring Dentists and Dental Offices

Please submit the following information to our office. Any radiographs can be sent with the patient or emailed to our office at info@avieoralsurgery.com

We will reach out to the patient to schedule an appointment as soon as possible. Thank you very much!

Referral Request

Avie Oral Surgery Group

Dr. Edna Buckle

1215 Annapolis Road Suite 205
Odenton, MD, 21113
United States

443-741-0696

Patient Name *
Patient Name
Name of Patient to be Seen
Phone *
Phone
A good phone number where we can reach the patient
Primary or permanent teeth or both.
Services to be Performed
Any specific instructions