Information for referring Dentists

Thank you for your interest in Advanced Endodontics of Wellington, a dental practice dedicated exclusively to root canal treatment and all other endodontic care. We are great at what we do! Our training, technology, and expertise will make your patints' experience smooth and painless. Dr. Taras Roud, Dr. Lesleigh Payne, Dr. Nelson Guanche, and our entire team make it a priority to provide our customers with excellent and prompt service. If you would like additional information, please don’t hesitate to contact us at 561-333-2522.

Please fill out the form below to refer a patient to our office. After submitting the form, you will be able to save a summary of the referral and directions to our office.

Patient Information

Patient Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Email

Phone Number

Referring Doctor Information

First Name

Last Name

Email

Phone Number

Teeth Needing Treatment - List by number

Requested Treatment

Restoration

Medications prescribed

Comments/Special Instructions

Referral Card

Referral Card Fill out

What to Expect for First Visit

Referring Dentist

Information for referring Dentists