Online Referral Form

You may refer patients to our office by filling out our secure online Referral Form. After you have completed the form, please make sure to press the Complete and Send button at the bottom to automatically send us your information. The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it.

Downloadable Referral Form

Downloadable Referral Form (PDF)

Request Referral Pads

We value your partnership tremendously and thank you for entrusting us with your patient’s oral surgery needs.

Referral Pad Request Form

If you need additional referral pads, please fill out the form below and we will get them over to your office.

Clinic Name*
Email*
Clinic Address*
Street Address City State ZIP Code
Number of Referral Pads Requested*
Questions/Comments
Preference
This field is for validation purposes and should be left unchanged.

Want to schedule a consultation with Dr. Stockton, Dr. Hostalet, Dr. Shelton or Dr. McDonough? Call our Oral Surgery office in Avon at Avon Oral & Maxillofacial Surgery Office Phone Number 317-272-2200.

Avon Oral & Maxillofacial Surgery
Oral Surgery

Referring Doctors

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Dental Implants

Feel and function like natural teeth

A natural tooth consists of a root and a crown. If you compare natural teeth to implant-supported replacement teeth, you'll see they have the same basic parts. Both have a crown (the visible part used to chew food). Both have a root that holds the tooth securely under the gum and is anchored into the jaw. The difference is that the implant is made of titanium – the same time-tested material used by surgeons for artificial joints. When you lose a tooth, you lose both the root and the crown.

Online Referral Form

Downloadable Referral Form

Request Referral Pads

Referral Pad Request Form

Avon Oral & Maxillofacial Surgery

Proudly serving Avon and surrounding areas;

Oral Surgery Treatments