Doctor Referral


Doctor & Medical Referrals

If you have any questions and would like to speak with us directly at Eastside Periodontics and Implantology, give us a call directly at 503-667-2442.

Online Referral Form

Fill out the referral form below and we’ll get back to you as soon as possible.

    Films MailedFilms with PatientPlease Take FilmsRadiographs e-mailed to gresham@eastside-perio.comRadiographs e-mailed to

    Is PlannedWill Be Planned After Periodontal EvaluationIs Not Indicated

    Full Mouth DebridementScaling and Root Planning

    Full Mouth DebridementScaling and Root PlanningComplete Periodontal Evaluation and TreatmentLimited Periodontal Evaluation and TreatmentImplant Evaluation and Treatment

    Download Referral Form

    If you are a medical professional and would like to refer us a patient, please download a referral form below and fax it to 503-669-8876.