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Referring Doctors

Thank you for taking the time to refer a patient to Mikolich Orthodontics, please take a moment to fill out the form below. A member of our team will be in contact with your patient as soon as possible. If you have any questions about our practice or the services we offer, don’t hesitate to give us a call.

Evaluate for interceptive treatment Evaluate for orthodontics Evaluate for orthodontic surgery Pre-prosthetic treatment needed Other Please call before treating Radiographs have been sent after seeing patient Recent panoramic x-ray was taken * X-rays can be sent to smile@canfieldbraces.com