Referrals
If you know anyone in need of our services CLICK HERE to download and complete the referral form. We appreciate your referral.

Along with your referral, we will need an original H1263-B form completed, signed and mailed to our office from the social worker in order to schedule the patient.

If you do not have an original H1263-B CLICK HERE to download one or please email Amy@mobiledentalcare.com or call our office at 214.750.6860 and we will promptly e-mail or fax a blank copy of the form. If when making a referral the social worker finds that a patient is full vendor, please send the referral with the “full vendor” box checked.