Dentists Referring Patients for Oral Surgery Procedures in New Jersey

Submit Your Patient Referral Online Here

You may refer patients to our office by filling out our secure online Referral Form (blue box) below. 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 take every precaution to protect it upon receipt.

Online Referral Form

WHY REFER YOUR PATIENTS TO OUR PRACTICE?

  • Drs. Jacobs and Kirsch are Board Certified Oral & Maxillofacial Surgeons. This voluntary certification assures patient care will be provided at the highest level anywhere in the world
  • The NJ Center for Oral Surgery strives for every patient encounter to be one of efficiency, compassion, and comfort.
  • We treat patients using up-to-date methodologies that are literature supported and time tested as well as being at the forefront of cutting edge surgical techniques and materials.
  • We will communicate with your office to ensure your patient is treated transparently and in conjunction with your office’s recommendations.

Emailing Images to NJ Center for Oral Surgery

To refer your patient to us simply send us an email to [email protected] with the patients name, telephone number, and reason for referral. Within one business day, we will call your patient to schedule an appointment.

Please click here to login and send us secure patient information through email.

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You may also print the referral form below and fax it to us a 973-226-7876 or give it to your patient.

We look forward to helping your patient.