Patient Referrals

Refer A Patient

At Bend Oral, Facial & Implant Surgery, we take pride in providing the highest level of surgical care for your patients. We understand the importance of a trusted partnership between referring providers and specialists, ensuring that your patients receive compassionate, expert treatment with seamless communication and follow-up.

Why Refer Your Patients to Bend Oral Surgery?

Expert Surgeon – Dr. DeLisi is a Board Certified Oral & Maxillofacial Surgeon with decades of experience.
Comprehensive Care – Specializing in wisdom teeth, dental implants, bone grafting, and facial trauma.
Advanced Technology – 3D imaging, guided implant placement, and cutting-edge anesthesia methods.
Hospital & Trauma Expertise – Combat military surgeon and senior attending surgeon at St. Charles Medical Centers.
Fast & Reliable – Emergency and urgent care availability, plus veteran and cash discounts.

Refer A Patient

Referrer Information:

Date

Referring Facility

Referrer Phone Number

Referrer Email

Primary Care Provider (if different than referrer)

Patient Information:

Patient Name (Prefix)

First Name

Middle Name

Last Name

Suffix

Patient Date of Birth

Patient Address

Street Address 1

Street Address 2

City

State

Zip

Country

Patient Phone Number

Primary Insurance
We consider medicare primary billing.

ID #

Group #

Insurance Plan Name

Secondary Insurance

ID #

Group #

Insurance Plan Name

Medical Concern

How long has the patient had the wound?

Please attach the patient's most recent medical chart and notes to include medications, medical history, info, progress notes, patient insurance, and license info.

Only accept image and pdf file

Other Comments

Testimonials

What Our Patients Say

Our mission is to provide surgical excellence to those in need with compassion, comfort, and empathy.