info@drgretelpellegrini.com
Referral Checklist
Referring Doctors

Refer a patient for periodontal or implant care.

Complete the form below and it will be sent directly to Dr. Pellegrini's office. Most referrals are scheduled for consultation within one week, and your patient is returned to your care once treatment is complete.

Patient & referral details

Referring Practice
Patient Information
Reason for Referral
Preferred Location
Urgency
Clinical Notes

Please email radiographs or scans separately to info@drgretelpellegrini.com, referencing the patient's name.

Submitting opens a pre-filled email in your default mail client, addressed to our office.