Refer a Patient to Our Oral Surgeon in Charlotte NC
Thank you for trusting us with your patient. Download the referral form below, or simply call or email the office — whichever is quickest for your team. Every patient you send is examined and treated personally by Dr. George Y. Soung, and we send a report back to your office after each consultation and procedure. We accept most major insurance plans.
Download the Referral Pad
Print it, fill it in, and fax or send it with your patient. Opens as a PDF in a new tab.
(704) 583-5217
Monday – Thursday: 8:00 AM – 4:00 PM · Friday: 8:00 AM – 1:00 PM · Saturday – Sunday: Closed
office@westballantyneoralsurgery.com
Send the completed form and any imaging as attachments.
What to Include
- Patient’s full name, date of birth, and contact information
- Relevant medical and dental history
- Recent radiographs or imaging (if available)
- Reason for referral and any specific concerns
- Insurance information, if known
Cases We Accept
- Wisdom teeth and impacted teeth removal
- Dental implants and bone grafting
- Oral pathology evaluation and biopsy
- Surgery to assist orthodontics (expose and bond, uprighting, TADs, frenectomy)
- Complex extractions and surgical extractions
- IV sedation and anesthesia management
Send a Referral Online
Prefer not to print? Let us know a patient is coming and we will take it from there. This is a short form on purpose — just enough to open the referral and reach your patient. We will contact them to schedule, request any records we need, and send a report back to your office after their consultation and again after any procedure.
Ready to Refer a Patient?
Download the referral pad, call the office, or email us the details. We will contact your patient to schedule, and send a report back to you after every consultation and procedure.