DDS Referral | Apex Oral Surgery

2176 Capital Cir SE Suite 304, Tallahassee, FL 32301
Phone (850) 752-4565
Fax (754) 999-9082
www.apexoralsurgery.org

Today's Date:

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Patient's First Name:

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Patient's Last Name:

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Telephone

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Referred for extraction of teeth indicated:

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X-rays

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Take new films

Implant Consultation

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Orthodontic Surgery Consulation

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Biopsy

Referred by Dr.

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General anesthetic instructions prior to surgery:
(If you are to sleep): Do not eat or drink anything for at least 6 (six) hours before surgery. Make arrangements for someone to drive you home following surgery.

Apex Oral Surgery

2176 Capital Cir SE Suite 304, Tallahassee, FL 32301
Phone (850) 752-4565
Fax (850) 752-4565

To complete your health history forms prior to your appointment, please go to www.apexoralsurgery.org and click on patient forms.

Please follow the prompts, complete forms, print and bring to your appointment.