Referring Doctors

Refer a Patient to One Endodontics

We partner closely with referring dental practices across Northern Virginia. Every patient referred to us is treated with care — and always sent back to your office for restorations.

Submit a Referral Online Download Referral Forms

Falls Church 703-783-2345 Sterling 703-844-9070 Gainesville 703-745-5698 Fredericksburg 540-225-1605

Printable Forms

Download Referral Forms

Prefer to fax or hand-deliver a referral? Download the appropriate form for your patient's location.

Falls Church, Sterling & Gainesville

Use this form for referrals to any of our three Northern Virginia locations.

Download PDF →

Fredericksburg

Use this form for referrals to our Fredericksburg location specifically.

Download PDF →

Online Referral

Submit a Referral

We'll follow up promptly to schedule your patient.

Patient Information

First Name *

Last Name *

Date of Birth *

Phone Number *

Patient Email

Referring Doctor

Dentist Name *

Practice Name *

Practice Phone *

Preferred Location

▼

Clinical Notes

Reason for Referral

Patient information is handled in accordance with HIPAA guidelines.