Referral Form

We welcome referrals from dental professionals in Houston, Texas, and surrounding areas to visit our practice for their oral and maxillofacial needs. Referring dentists should fill out the referral form provided on this page in preparation for their patient’s appointment with Dr. Jose Lopez at our office. If you have any questions about our referral form, please contact our oral surgeon and team at 713-622-8607.

Online Referral Form

Printable Referral Form