For dentists and physicians

Pediatric Dentist Referral Form

Refer a child to Kids Dentist Plus. We care for infants, children, teens and patients with special health care needs at our Sacramento-area offices, and we accept Medi-Cal.

Medi-Cal accepted

Special health care needs welcome

Smiling girl with curly hair outdoors

Referring a patient to Kids Dentist Plus

Dentists, physicians and other providers can refer children to any of our Sacramento-area offices. We see infants, children and teens through age 20, including patients with special health care needs, and we accept Medi-Cal.

Who we see

  • Infants, children and teens through age 20
  • Children with special health care needs
  • Anxious children who may need laughing gas (nitrous oxide)
  • Dental pain, swelling or injuries

What to include

  • Patient name, date of birth and parent or guardian contact
  • Reason for the referral and how urgent it is
  • Relevant X-rays, records or notes
  • Insurance or Medi-Cal plan information

After you refer

We’ll follow up with the family to schedule a visit at the office that suits them. Families can also call us directly at (916) 226-6767. For an urgent referral, please call us.

Send a referral

Complete the form below to refer a patient. For an urgent referral, please call us at (916) 226-6767.

Where we see patients

Families can choose the office closest to home:

Questions about a referral?

Call (916) 226-6767.