Our Referral Program

Welcome to Our Patient Referral Program!

Referrals are not only our favorite form of flattery, they are also an amazing source of business for our practice.

We love that we’re making you happy and that you want to help spread the word!


As a thank you for your kindness, we're offering a FREE GIFT:

A $50 Amazon Gift Card.








Two Ways to Earn the Gift

  1. Use the form below to provide the name and email address for someone who may be interested in starting braces or Invisalign in the near future. If the person you refer starts treatment, you AND the person referred will both earn the prize.

  2. Have a friend or family member mention your name during their initial exam before they sign-up for treatment.

Gift Card 50_edited.jpg
Your Information

Your Friend's Information

Thanks for submitting!