Special Offers

Tri State Dental Care

150 Tower Rd. Ste. 100, Dakota Dunes, SD 57049

(605) 242-7123

Refer a Friend

Office Location | Appointment Request | Comment Form | Refer a Friend

A successful practice doesn't just happen. It is the result of a strong commitment to excellence in our treatment 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.

Choose a form:

» Patient Referral
» Doctor Referral

Doctor Referral Form

If you are a doctor who is referring a patient to us, please fill out and submit the following form.

Your Information:

Your Name:

First

Last
Your Practice Name:

Full Practice Name
Email Address

Valid Email Address

Referral Information:

Name of Person You're Referring:

First

Last
Were Radiographs Sent?

Yes No

When were they sent?
Additional Information:

Comments:

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Tri State Dental Care | 150 Tower Road Ste 100 | Dakota Dunes, SD 57049

Tri State Dental Care

Serving Sioux City & Dakota Dunes

Refer a Friend

Choose a form:

Your Name:

Your Practice Name:

Email Address

Name of Person You're Referring:

Were Radiographs Sent?

Additional Information:

For Security Purposes, Please Enter the Code Below: