Pediatric Dental Specialists of Indiana, P.C.

For Referring Providers

Referral information and printable resources for dental professionals referring children to our Kokomo office.

Thank You for Your Referral

Thank you for considering our office to help care for these amazing children. We appreciate your trust in Pediatric Dental Specialists of Indiana, P.C.

We like to review each patient’s information prior to their visit so our doctors can be prepared for their individual needs. When referring a patient, please provide:

1The child’s most recent prophylaxis and examination information.

2Any current radiographs, including panoramic X-rays, bitewings, and periapical (PA) X-rays.

Please print and complete our referral form and provide the requested records with the referral.

Printable Referral Form

Our referral form is provided as a printable PDF. It is intended to be printed and completed by the referring office and is not submitted through this website.

To use the form:
Open the PDF, print it, complete it by hand, and provide it with the patient's referral information and available records.

View / Print Referral Form

Contact Our Office

If your office has questions about a referral or the records needed for a patient, please contact Pediatric Dental Specialists of Indiana, P.C.

Office2705 S Berkley, Suite 2B
Kokomo, IN 46902

ContactPhone: 765-453-2267
Fax: 765-453-1150

HoursMonday–Thursday
8:00 AM–5:00 PM

Call 765-453-2267