Welcome to First Coast Oral Surgery
Referred Patients

Your initial appointment will consist of a consultation explaining your diagnosis and treatment options. Occasionally, surgery can be performed the same day as the consultation. However, a complex medical history or treatment plan may require an evaluation and a second appointment to provide treatment on another day. If you plan to have IV sedation for your surgery, please have nothing to eat or drink eight hours prior to your surgery. You will also need an adult to drive you home.

Referral Form
Referral X-Rays
Download Referral Form

Patient Referral Form

Referring Doctor's Information

Patient's Information

MM slash DD slash YYYY
Reason
Max. file size: 15 MB.
Max. file size: 15 MB.

To the best of my knowledge, the questions on this form have been accurately answered. I understand that providing incorrect information can be dangerous to my (or patient's) health. It is my responsibility to inform the dental office of any changes in medical status.
Consent

SEND REFERRAL FORMS TO:

If you prefer to submit your referral via paper form, please download the referral form and return it to our office. Please send all forms to:

JACKSONVILLE

7711 Baymeadows Rd E.
Suite 7, Jacksonville, FL 32256

PHONE: (904) 565-1505
FAX: (904) 565-1506
EMAIL: [email protected]

AMELIA ISLAND

960115 Gateway Boulevard #1
Fernandina, FL 32034

PHONE: (904) 491-0111
FAX: (904) 491-0222
EMAIL: [email protected]

ORANGE PARK
1495 Kingsley Ave. Orange Park, FL 32073

PHONE: (904) 272-8484
FAX: (904) 491-0222
EMAIL: [email protected]

LAKE CITY
1779 SW Barnett Way Suite 103, Lake City, FL 32025

PHONE: (904) 272-8484
FAX: (904) 491-0222
EMAIL: [email protected]

PALM COAST
20 Cypress Point Parkway Suite B, Palm Coast, FL 32164

PHONE: (386) 232-5076
FAX: (904) 565-1506
EMAIL: [email protected]

REFERRING DOCTOR’S X-RAYS

If your dentist or physician has taken x-rays you may request that they forward them to our office. Simply have your dentist’s office email the films to your prefered First Coast location. If additional films are necesary they can be taken at our facility.

Your initial appointment will consist of a consultation explaining your diagnosis and treatment options. Occasionally, surgery can be performed the same day as the consultation. However, a complex medical history or treatment plan may require an evaluation and a second appointment to provide treatment on another day. If you plan to have IV sedation for your surgery, please have nothing to eat or drink eight hours prior to your surgery. You will also need an adult to drive you home.

**IMPORTANT: All patients under the age of 18 must be accompanied by a parent or guardian at all visits.

Please alert the office if you have a medical condition that may be of concern prior to surgery (i.e., diabetes, high blood pressure, artificial heart valves and joints, rheumatic fever, etc.) or if you are currently taking any medications (i.e., heart medications, aspirin, anticoagulant therapy, etc.).