Dental Treatment Under Anesthesia/Sedation Referral Forms

To better serve you, we offer three types of treatment referrals:

Dentist Referral (Tiny Tooth “In-house dentist” performs treatment with anesthesiologist at Tiny Tooth Office).

Credentialed External Treating Dentist Referral (Credential external dentist performs treatment at Tiny Tooth Office and Tiny Tooth performs anesthesia).

Mobile Anesthesia Referral (Tiny Tooth provides anesthesia at referring dentist office, while referring dentist is performing treatment).

Please select the specific form for your referral information and instructions.

Referral Service Options

Tiny Tooth Referral Pad
Credentialed External Dentist Treating at Tiny Tooth Referral
Mobile Anesthesia/Sedation in your Dental Office Referral
Dental Referral for In-House Treatment at Tiny Tooth

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