We appreciate the confidence you’ve placed in us to provide your patient with their orthodontic care and we thank you for recommending our office to your patients, friends, and family.

Please feel free to download our referral form or fill out the online form below and submit it immediately.

Doctor Information:
Patient Information:
Date of Birth:
Patient Last Prophy Date:
Patient Last Pan or FMX Date:
Please email radiographs to doctorb@brownorthodontics.com
Concerns and Additional Information:
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