During this time, the referral forms may not funciton as expected.
Estimated Completion: 3:00pm EST


Please locate the service needed for your patient and use the appropriate means below to begin the referral process or to find out more about the services offered by the University of Michigan School of Dentistry.

If you have a technical problem with a referral form, please use the "Provide Feedback" link near the top of the page. If you have questions for a specific department or regarding a certain patient, please use that department's website link below to find contact information (or use the phone number if provided below).

Comprehensive Clinical Pathology Services
Please use this form if you would like our team to evaluate and manage diseases affecting the oral and maxillofacial regions. These include (but are not limited to): autoimmune diseases (lichen planus, mucous membrane pemphigoid, etc and others), dry mouth, burning mouth syndrome, oral manifestations of systemic disease (Crohn’s disease, etc), fungal infections (candidiasis) leukoplakia and other pigmented lesions, neoplastic and reactive lesions (tumors and masses), or oral cancer. We will also determine if a biopsy is needed and help your patient get the additional recommended testing.
Cone-beam Computed Tomography (CBCT)
Cone-beam Computed Tomography (CBCT) site  
Dental Faculty Associates Clinic
Dental Faculty Associates Clinic website  
Dental Student Clinics
Dental Student Clinics website  
(734) 763-6933
Endodontics Clinic
Endodontics Clinic website  
Endo Form Endo Form
Graduate Restorative Clinic
General Dentistry Clinic website  
GradRest Form
Hospital-Based and Special Care Dentistry
Providing comprehensive dental care for patients ages 16 and above in a hospital or specialized setting for patients with special healthcare needs and/or medical complexity, including the treatment of oral infections, trauma, cancer, and comprehensive dental care for patients with complex dental treatment needs.
Hospital Dentistry at Michigan Medicine website  
Delta Dental Integrated Special Care Clinic at the School of Dentistry  
Obstructive Sleep Apnea Clinic
Obstructive Sleep Apnea Clinic website  
Obstructive Sleep Form
Outpatient Oral & Maxiollofacial Surgery at the School of Dentistry
Providing exposures, extractions (including wisdom teeth), implants, alveoplasty, frenectomy, tori removal, and biopsies (Hard or Soft Tissue, Infection, Drainage, etc.)
Oral & Maxiollofacial Surgery (Dentistry) website  
Oral Pathology Biopsy Service
Please complete this form only when you have a specimen (in formalin or other medium) to submit.
If you would like a patient to be evaluated for pathology with a possible biopsy or additional testing, please use this form: (Comprehensive Clinical Pathology Services)

Oral Pathology Biopsy Service website  
Biopsy Form
Adult Oral & Maxillofacial Surgery at Michigan Medicine
Providing adult surgical care for head and neck cancers; skeletal anomalies; jaw conditions; trauma reconstruction; and wisdom teeth extraction.
Oral & Maxillofacial Surgery/Dentoalveolar website  
Pediatric Oral & Maxillofacial Surgery at Mott Children's Hospital
Providing pediatric surgical care for head and neck cancers; skeletal anomalies; jaw conditions; and trauma reconstruction.
Oral & Maxillofacial Surgery/Dentoalveolar website  
Orthodontics Clinic
Orthodontics Clinic website  
Please call the orthodontics clinic for any external referral-related questions or requests 734-764-1520
Pediatric Clinic
Pediatric Clinic website  
Peds Form
Periodontics Clinic
Periodontics Clinic website  
Perio Form
Prosthodontic Clinic
Prosthodontic Clinic website  
Prosth Form
Temporomandibular Disorders and Orofacial Pain Clinic
Providing a thorough assessment and diagnosis of orofacial pain to provide management through a comprehensive and multidisciplinary approach.
Temporomandibular Disorders and Orofacial Pain Clinic website  
Hospital-Based Wisdom Tooth Clinic
Providing wisdom tooth extractions in a hospital setting for medically complex cases.

On April 23, 2023, the Wisdom Tooth Clinic referral form will no longer be available. All wisdom tooth extraction referrals should be sent using the "Outpatient Oral & Maxillofacial Surgery at the School of Dentistry" form above.

TWisdom Tooth Clinic website  
WT Form

Updated 2023-08-14