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A successful orthodontic practice doesn't just happen. It is the result of a strong commitment to excellence in orthodontics and in our relationships with patients and doctors. We’d like to take a moment to thank you for showing your confidence in our practice by recommending us to your friends, family and colleagues. We’re gratified to find how many new patients regularly call on us based on your words of advice.

Patient’s Referral Form

If you are a patient of record who has referred a new patient to us, please let us know by filling out and submitting the following form.
 
Today’s Date:
   
Your Name:
   
Your Telephone:
   
Your Email Address:
   
Full Name of the Patient You Are Referring:
   
Comments:
   
 

Doctor’s Referral Form

If you are a doctor who is referring a patient to us, please fill out and submit the following form.
   
Today’s Date:
   
Your Name:
   
Your Practice Name:
   
Your Email Address:
   
Full Name of the Patient You Are Referring:
   
Radiographs Sent? Yes No
If so, when?
   
Comments:
   
 

 
 

Dr. Keith J. Kohrs, Aurora and Strasburg’s Orthodontist for the Entire Family

Kohrs Orthodontics
Aurora Office: 2900-B South Peoria Street, Aurora, CO 80014, 303.750.3660
Strasburg Office: 56620 East Colfax Avenue, P.O. Box 179, Strasburg, CO 80136, 303.622.4570

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