Referring Doctors - Newell Orthodontics

Covid-19 Announcement

Patient Info
Procedures
- Fixed Appliances
- Invisalign
Online Forms
Referring Doctors
About Us
Contact

Referring Doctors

Full Name*
First Middle Last
Birth Date*
MM slash DD slash YYYY
Parent's Name*
First
Spouse's Name
First
Phone*
Address*
Street Address Address Line 2 City State ZIP Code
Referring Dentist
First
Reason for Referral
- Crowding
- Missing Teeth
- Ectopic Eruption
- Anterior Cross-bite
- Excessive Overbite/Open bite
- Spacing
- Extra Teeth
- Excessive Overjet
- Posterior Cross-bite
- Tongue Thrust
Radiographs
- Sent with Patient
- Mailed
- E-mailed
- Must Be Obtained
Scheduling
- Patient will contact our office for appt.
- We will contact the patient for appt.
- Referring offie has scheduled an appt. for the patient
Submit X-Rays
Max. file size: 256 MB.

SPIRIT LAKE OFFICE

Map
712-336-3428
611 18th St.
Spirit Lake, IA 51360

WORTHINGTON OFFICE

Map
507-372-7733
Avera Medical, 1216 Ryan Road
Worthington, MN 56187

WINDOM OFFICE

Map
507-831-2061
579 River Bend Plaza
Windom, MN 56101

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