Referral Form

The surgeons of Great River Oral & Maxillofacial Surgery are privileged to work with you to achieve the highest possible care for your patients. We’re committed to serving you and your patients with excellent clinical quality and exceptional customer service.

Our goal is to exceed your expectations and treat your patients as if we were an extension of your office. As an adjunct to your practice, Great River Oral & Maxillofacial Surgery supports you by:

  • Emphasizing the central role you play in your patients’ dental health.
  • Reminding patients to return to you promptly for follow-up care and/or routine hygiene.
  • Providing numerous practice support materials, brochures, and other patient information.
  • Being available when you need urgent Oral & Maxillofacial Surgery care for your patients.
  • Offering educational opportunities for the entire dental staff.

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 Submit 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.

We express our thanks to you for trusting us with your patients’ oral, maxillofacial and implant surgery needs.


Michael J. Dalton DDS

Thomas J. King III DDS, MD

Kimberly V. Pingel DDS

Justin W. Nagel DDS

Stephanie M. Dalton DDS