Brandon M. West, D.D.S., M.S.

Karl J Zeren, D.D.S.

Diplomates of the American Board of Periodontology
Practice Limited to Periodontics & Dental Implant Surgery

West Periodontics & Dental Implants

Referral Form

If you’re a dentist and interested in referring us, we’re pleased to meet you!

We want to make the process as painless as possible, so we’ve included a few options to get in touch.

You may fill our detailed form below, download it here, email us or give us a call!

Brandon M. West, D.D.S., M.S.

Karl J Zeren, D.D.S.

Diplomates of the American Board of Periodontology
Practice Limited to Periodontics & Dental Implant Surgery

9515 Deereco Rd., Suite #308, Timonium, MD 21093

Office: (410) 252-0871
Email: [email protected]

*Please email or mail us any previous radiographs related to the case* Is there a previous CBCT?
Referral for Periodontal Therapy (Please check/circle all that apply)
Comprehensive Periodontal Exam
Soft Tissue Grafting for Recession Repair Teeth #
Extraction(s)#
Dental Implant Site(s)#
Final Restorative Plan
Pre-Prosthetic Preparation Site(s)#
Biopsy – Oral Pathology Site(s)#
Impacted Tooth Uncovering for Orthodontic Treatment Site(s)#
Peri-implantitis – Implant(s)#
westperiodds.com
westperiodds.com
*Please email or mail us any previous radiographs related to the case*
Is there a previous CBCT?
Referral for Periodontal Therapy (Please check/circle all that apply)
Comprehensive Periodontal Exam
Pocket Reduction Surgery – Quads:
Dental Implant Site(s)#
Final Restorative Plan