For Doctors

Attn: Doctors, PA's, and/or Office Staff
Complete the patient referral information (below)

Doctor's Name *

* Indicates required field

Patient's Name *

Your Name *

Your Email *

Procedure/Instructions *

Remove the following teeth *

Medical History *

Upload File *

Max file size: 20MB

What else should we know? *

If the patient desires I.V. sedation or general anesthesia, he/she should be accompanied by a responsible adult and not eat or drink six hours prior to the appointment. Minors must be accompanied by a parent or guardian.

Submit

Jeffrey N. Hamlin, DMD, PC
1850 Whites Road
Kalamazoo, MI 49008

269.385.2101 Office/Emergency
hamlinoralsurgery@hamlinoralsurgery.com

Attn: Doctors, PA's, and/or Office Staff​Complete the patient referral information (below)

Attn: Doctors, PA's, and/or Office Staff
Complete the patient referral information (below)