Doctor Referral Form

To refer a patient, please download and fill-out one of our our Referral Forms.

Doctor Referral Form

Technical Note:

You need Adobe Acrobat Reader to view our form. Please download the free Acrobat Reader from Adobe’s web site if it is not already installed on your system.

Contact Us

Charlotte Root Canal Center

Office Hours
Monday: 08:00 AM - 05:00 PM
Tuesday: 08:00 AM - 05:00 PM
Wednesday: 08:00 AM - 05:00 PM
Thursday: 08:00 AM - 05:00 PM
Friday: 08:00 AM - 02:00 PM
Saturday: Closed
Sunday: Closed
**Mon-Thurs: Lunch break from 1-2 PM