Refer Our Office

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 other 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!

Refer a Friend

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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.

Refer a Friend
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Doctor Referral

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

Doctor Referral - Dental
Phone Type
May we call with questions?

Patient Information

Gender:
Phone Type
OK to leave message?
May we call the patient to schedule an appointment?
Are X-rays available?
Reason for Referral(check all that apply):

Area of Concern(check all that apply):

Permanent Dentition

Upper Right:
Upper Left:
Lower Right:
Lower Left:

Primary Dentition

Upper Right:
Upper Left:
Lower Right:
Lower Left:

The information that I have given above is correct to the best of my knowledge.



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Steven B. Hemenway, D.D.S.

  • Steven B. Hemenway, D.D.S. - 719 N. 39th Ave., Suite 100, Yakima, WA 98902 Phone: (509) 453-3610

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