Referring Providers | Rasmussen Prosthodontics

Partnering With Your Practice

Rasmussen Prosthodontics welcomes referrals from general dentists, oral surgeons, periodontists, and other specialists. Whether the case involves a single implant restoration or a full mouth reconstruction, we coordinate closely with your office and keep you informed at every step. Once treatment is complete, your patient returns to you for ongoing care.

Use the form below to send us a referral. If you'd like to attach radiographs, intraoral photos, or other imaging, you can upload them directly. For questions about a case before referring, please call our office.

Submit a Referral

All fields marked with an asterisk are required.

Patient Information

Patient First Name Please enter the patient's first name.

Patient Last Name Please enter the patient's last name.

Patient Phone Number Please enter a valid phone number.

Patient Email (optional) Please enter a valid email address.

Preferred Location Please select a location.

Referring Provider Information

Provider First Name Please enter your first name.

Provider Last Name Please enter your last name.

Referring Practice Name Please enter your practice name.

Practice Phone Number Please enter a valid phone number.

Practice Email Please enter a valid email address.

Reason for Referral

Select all that apply.

Fixed Prosthodontics Removable Prosthodontics Implant Restoration Comprehensive Treatment

Comments, Special Concerns, or Other Reason (optional)

Attachments

Attach x-rays, intraoral photos, treatment plans, or any other supporting files. Accepted formats: JPG, PNG, PDF, TIFF, DICOM. Maximum total size: 20 MB.

Choose Files No files selected One or more files exceed the size limit.

A note on patient privacy: Please transmit only the information necessary to establish the referral. For complete records, radiograph files, or any sensitive medical information, our office will follow up with you directly through a secure channel.

Our team responds to referrals within one business day. If you need to reach us sooner, call the SLC office at 801-352-7889 or Vineyard at 801-492-0017.

Prefer to Call?

You are always welcome to call our office directly to discuss a case, request records, or check on a shared patient.

SLC: 801-352-7889 Vineyard: 801-492-0017