Smiles by Goh Referrals

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Smiles by Goh Referral

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Patient Information

Patient's Name*
MM slash DD slash YYYY
Does The Patient Require Antibiotics Prior to Dental Treatment?*
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Referring Doctor Information

Referred By*

Procedures

Extractions*
Full Mouth Implants*
Single Implant*
Bone Grafting*
Sedation*

Extracting Information

tooth number chart

Radiographs or Clinical photos

Radiographs / Clinical Photos*
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Case Notes

Smiles by Goh

2653 W Horizon Ridge Pkwy #110
Henderson, NV 89052
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Hours

Monday: 8:00 AM - 5:00 PM
Tuesday: 8:00 AM - 5:00 PM
Thursday: 7:00 AM - 3:00 PM
Friday: 7:00 AM - 1:00 PM

Phone

702-732-3754

Email Address

[email protected]