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.

Referral Form


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.
  • This field is for validation purposes and should be left unchanged.

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