Referral Form

IntroductionReferral Form

You may refer doctors to our office by filling out our Referral Form. After you have completed the form, please make sure to bring it into the office on your next visit.

Technical Note:

Our forms use the Adobe Acrobat viewer to allow doctors the convenience of completing their referral form from home or work. Please download the free plugin from Adobe's web site if it is not already installed on your system.























Dr. Stephen C. Dwyer | Dr. M. James Clark | Dr. Charles M. Repa | Dr. Dan W. Williams, Jr. | Dr. Brian M. Unterman | Dr. Zahid S. Lalani | Dr. Cecil R. Shrewsberry

Louetta Office: 8687 Louetta Road, Suite 100, Spring, TX 77379 • Phone: 281-370-4034
Conroe Office: 2249 N. Loop 336 West, Suite A, Conroe, TX 77304 • Phone: 936-756-8188
Medical Plaza Office: 1001 Medical Plaza Dr, Suite 370, The Woodlands, TX 77380 • Phone: 281-363-3241
Technology Forest Office: 4185 Technology Forest Blvd. Suite 100, The Woodlands, TX 77381 • Phone: 281-367-2001
Sterling Ridge Office: 10333 Kuykendahl, Suite A, The Woodlands, TX 77382 • Phone: 281-364-9933
Huntsville Office: 3200 Robinson Creek Pkwy. Suite A, Huntsville, Texas 77340 Phone: 936-439-9572

Northwest Oral & Maxillofacial Surgery your Houston Oral Surgeons provide Oral Surgery procedures including:
Bone Grafting, Wisdom Teeth, Oral Pathology, Impacted Canines, Facial Trauma, Jaw Surgery, TMJ Disorders, and Dental Implants.

Houston Oral Surgeons serving Montgomery County, Harris County and Houston-Sugar Land-Baytown Metropolitan Area, including The Woodlands, Spring, Conroe, Huntsville,
Houston, Magnolia, Montgomery, Tomball, Madisonville, Pinehurst, Humble and Kingwood.