Referring Doctor Form
Please also refer to our COVID-19 and Dental Emergencies page.
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).
Please call us if you have any questions: Forsyth IL Periodontal Office Phone Number 217-876-0547 (Forsyth) or Springfield IL Periodontal Office Phone Number 217-787-0422 (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.
We are closed for lunch from 12:00 PM - 1:00 PM Monday - Thursday