Refer a Patient

Refer a Patient

Refer a patient to Dr. Wang

Thank you for entrusting your patient to our care. Complete the secure form below and our team will coordinate scheduling directly with the family. All information is transmitted over an encrypted, HIPAA-compliant connection.

"*" indicates required fields

1

Referring office

Tell us who's sending this referral

2

Patient Information

The little one we'll be caring for

MM slash DD slash YYYY
3

Referral details

What you'd like us to help with

Reason for referral / service requested*
please check all that apply
Accepted file types: pdf, jpg, png, dicom, Max. file size: 25 MB.
optional (X-rays, photos, charting)

Keeping Care Inclusive

Our Accepted Insurances

Trusted Pediatri Image

Mission Peak Pediatric Dentistry is dedicated to delivering quality-focused, accessible pediatric dental care for all Fremont families. Which is why we accept a broad spectrum of dental insurance plans at our practice. Have any questions about your child’s treatment options? Our team is here for you! We’re always happy to help you understand and make the most of your child’s benefits, so they can receive the specialized care they need and deserve for a healthy, happy smile.