Refer a Patient

For doctors' use only. Send a referral to Dr. David Frey, DDS, at our Beverly Hills office with the form below.

Patient Referral Form

Please fill out the form below to refer a patient to Dr. David Frey. After you send it, you can print or save a summary of the referral and directions to our office.

Required fields

Patient Information
Referring Doctor Information
Teeth Needing Treatment

Tap each tooth that needs treatment, if any.

Reasons for Referral (required, choose at least one)
Attach Files

Drag x-rays, photos or documents here

or

JPG, PNG or PDF. Up to 5 files, 15 MB in total.

    Symptoms and Referral Notes

    Prefer to fax or email the form?

    Download the referral form at the bottom of this page and send it to our Beverly Hills office.

    Download the form.

    Fill in the referral request and send it to our Beverly Hills office by fax or email.

    Have symptoms / questions?

    Text:
    310.276.4537 (US only)
    WhatsApp:
    +1 818.601.2253 (International)
    Email: