Refer a Patient

Help Your Patients Get the Smile They Deserve!

We’re thrilled that you’re considering referring your patient to Holy City Orthodontics! Our goal is to provide top-notch orthodontic care in a welcoming and friendly environment. Referring a patient to us is a breeze and ensures they receive the best care possible.

Why Choose Us?

Dr. Anderson and our awesome team use the latest techniques to create beautiful smiles.
Every patient is unique, so we design personalized treatment plans just for them.
From braces to clear aligners, we’ve got all the options to fit your patients’ needs.
We’ll keep you in the loop about your patient’s progress every step of the way.
Our office is easy to get to, and we offer flexible hours to fit busy schedules.

Get Started

Referring a patient is simple. Just fill out the form below! If you have any questions, just call us at (843) 823-3533.

"*" indicates required fields

Patient Name*

Parent/Guardian Name (if applicable)

Patient Date of Birth*

Patient Email*

Referring Doctor Name*

Referring Contact Phone

Referring Contact Email*

Additional Information

Upload Digital X-Rays

Max. file size: 100 MB.

Consent to text and email

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