For Doctors

To Our Referring Pediatricians and Dentists,

For your convenience our office has provided a Doctor Referral Slip. Please feel free to Print This Form and Fax to our office or have the patient bring the completed form with them to their first visit to our office.

If you or your staff have any problems getting these files to print properly, please call our office @ (301) 408-3131 and we will gladly assist you!

Also please inform parents that a parent or legal guardian must accompany the child to this first visit to our office.

Thank You so much!

Hill Pediatric Dentistry 
10230 New Hampshire Ave., Suite 104
Silver Spring MD 20904
Ph: (301) 408-3131
Fx: (301) 408-3141