Helping Colleagues

Referral Form
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We’re On Your Team

As one of the premier “go to” specialist practices in South Florida, Dr. Camacho and his team are dedicated to helping dentists and specialists provide the best results possible for their patients. We’re here to serve you, your practice, and your patients.

Expect The Best

When you invite us to work with you in serving your patients, your patients can expect meticulous treatment planning, thorough execution, and excellent results. Working together helps us do it right the first time.

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Save An Appointment

Dr. Camacho’s unique digital workflow allows for more effective team treatment planning, better restorative outcomes, and a more efficient experience for referrals. His innovative approach creates the opportunity to reduce the number of appointments required.

Seamless Experience

We seek to be more than simply a place where you send patients for specialized treatment. Our collaborative approach means we work with you to help your patients experience a seamless continuum of care throughout their entire treatment process.

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Please fill out the referral form below.

Provider Referral Form

Your Information

Patient Information

Which doctor are you referring this patient to?


Background Information

1. How long as he/She been a patient?

2. When did you first recommend he/she see a specialist?

3. Has a prophy been done at GP's office in the last 6 months?

5.What recall cycle has the patient been on?

Recommended Treatment(s)

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A Complete Series...

Anticipated Treatment Plan

What would your ideal treatment plan be?

To Help Us Better Prepare

Is the patient physically handicapped?

Is premedication needed?

Is the patient Highly Apprehensive?

Additional Information

Thank you! Your referral has been sent.
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connect with us

We look forward to meeting you. Call (954) 772-3600 or request an appointment online to set up your first visit. We’ll be in touch soon.