Online Referral Form

You may refer oral surgery patients to our offices by filling out our secure online Referral form. After you have completed the form, please make sure to press the Submit button at the bottom to automatically send us your information.

After you submit your Referral form, you will have the opportunity to securely upload and transmit images of patient x-rays.

Clickable button to launch a secure, online Oral Surgery Doctor Referral form

The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it.

Call our office if you need assistance: Franklin Lakes Phone Number 201-848-5015.

Secure email

To receive an invite to Collaborator, our HIPAA-secure fileshare and patient case management system, call our office at Franklin Lakes Phone Number 201-848-5015 or send an email request to Dr. Costello!