Referring Doctors

Online Referral Form

You may refer patients to our office by filling out our secure online Referral Form. After you have completed the form, please make sure to press the Complete and Send button at the bottom to automatically send us your information. 

The security and privacy of patient data are one of our primary concerns and we have taken every precaution to protect it. Contact Southern Minnesota Periodontics, P.A. for more information.
Referral Form
Patient with dentist

Referring Doctors

Please download and fill out our patient referral form. After you have completed the form, please fax a copy of this referral to 507-345-7538 or feel free to send it via mail, or email perio@jernbergdds.com. Thank you!
           
Technical Note: You need Adobe Acrobat Ready to view our form. Please download the free Acrobat Reader from the Adobe's website.

Self-Care Program for the TMJ and Jaw Pain

Download our information regarding TMJ self care and exercises for your patients.
Call us today to learn more about our referral program.
507-345-7537
FREE parking available!
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