Harrison Implant & Oral Surgery Center Online Patient Referral Form

At Harrison Implant & Oral Surgery Center, we value our relationships with referring dental practices and are proud to partner with you in providing excellent oral healthcare to our community.

You may refer 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.

On your patient’s first visit to our Harrison NY office, we will have your completed form available. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

Technical Note:

PC Users
Our online form uses Adobe Acrobat Reader 5 or greater plug-in to conveniently submit the form from home or work. Please download the free plug-in from Adobe’s web site if it is not already installed on your system. It is important that you have at least version 5 of the plug-in to successfully use our online form.

Mac Users
You must open and submit the form in a Safari Browser with the latest iMac operating system. It is also important to have the latest version of Adobe Acrobat Reader on your computer in order to submit your form to our office correctly, please download the free plug-in from Adobe’s website.

To achieve a high level of trust with our shared patients, we:

  • Review cases thoroughly in advance
  • Refer back to your office for restorations
  • Collaborate with you on treatment plans
  • Are available in an advisory role if requested
  • Offer accommodating scheduling
  • Provide timely assessments and imaging

We have a selection of tools and resources assembled here such as our referral form and links to articles you may find interesting. If you have any questions about our practice, please call us at Harrison Implant & Oral Surgery Center Phone Number 914-777-7171.

Above all, we want to thank you for your referral of our office.

Office Hours

Monday through Saturday:   9:00 AM - 5:00 PM