Referring Doctors - Impact Orthodontics

4256 Nicollet Ave, Minneapolis, MN 55409

Referring Doctors (612) 315-1511

Welcome to Impact Orthodontics!

We appreciate your trust in our practice. Here, you’ll find resources to facilitate patient referrals and communication.

Referring Doctors

Patient Name(Required)

Patient Email(Required)

Patient Phone(Required)

Referring Doctor(Required)

Date of Birth(Required)

Date of Last Cleaning

Date of Last Panoramic Radiograph

Additional Information