Saint Louis University

For records requests please download the authorization form below and return it to our office once completed.  A fee may be charged for duplications costs.
Click here to download the Orthodontic records request form.

Endodontics and Periodontics
Generally a referral from a physician or dentist is necessary. This can be arranged by phone, 314-977-8381 or by downloading the patient referral form below. Please call to request patient referral forms for your office. The form can be faxed to our office at 314-977-8383.
Click here to download the Endodontic and Periodontic referral form.

Imaging Center
Please use the following form for referring a patient to our Imaging Center for a CBCT scan.
Click here to download the Imaging Center referral form.