Please complete the form and click “submit” to send us your referral. We will respond to your inquiry as soon as possible. You may also print this referral form and the patient will be on his/her way!
For our patients on Medicaid, Medicare, or with government funded insurance, please be aware that we do not work with these programs or accept their benefits. We would be more than happy to discuss alternative payment options, outside of Medicaid, Medicare, or a government funded plan. Please feel free to inquire about your options at Advanced Dentistry of Kearney. We are here to help!
