► Accepted Insurance ► Referring Doctors

Call 888.898.8124

"You are an exceedingly impressive organization. Thank you for your marvelous service."

Barney from Hudson

Hours of Operation

Monday - Thursday 7:00 - 4:00
Friday 7:00 - 1:30 

Same day appointments
available

River Heights Endodontics Referral Form






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 Cold
 Hot
 Percussion
 Biting

 Oral/Facial Swelling
 Tenderness
 Fistula

 Tooth history includes crack/fracture.
 Patient has vague unlocalized pain in area indicated.
 X-ray reveals radiolucency.
 Pulp was exposed or possibly exposed.
 Tooth was opened and temporized
 RCT is necessary for restoration.
 Prior RCT appears to be failing.
 Please place final restoration in access opening.
 Please create post space.




 

General Instructions

Please take some time to answer these questions for the patient you are referring.

If you are unable to complete the form, please click here, to download a copy of our patient referral form that you can fill out and fax back to our offices at (715) 386-8958.

For questions you can contact Dr. Ben Fravel by emailing Fravel@riverheightsendo.com or Dr. Aaron Wachlarowicz by emailing Wachlarowicz@riverheightsendo.com