Referring Doctor Form
The practice of Magnolia Pedraza, DMD, MS has provided a referral form for our referring doctors. Please click the button below to download a PDF version of the form to print and fill out. You may fax the completed forms to us. Our fax numbers are 217-876-0601 (Forsyth) and 217-787-0425 (Springfield).
If you are not able to open this file, you may need to download Acrobat Reader for free and use it to open our Referral form.