For Healthcare Professionals
Professional Referral Form
Thank you for trusting Seaport Smiles with your patient's orthodontic care. Our secure referral form ensures seamless communication and the best possible treatment outcomes for our mutual patients.
HIPAA Privacy Notice
We value your privacy and comply with the Health Insurance Portability and Accountability Act (HIPAA) to protect your personal health information (PHI).
- •Any information submitted through this form, including patient data and uploaded files, will be securely transmitted and used solely for referral and treatment purposes.
- •We use encryption and secure storage protocols to safeguard your data from unauthorized access.
- •By submitting this form, you authorize Seaport Smiles to share your information with the relevant healthcare providers as necessary.
For questions, please contact hello@seaportsmiles.com
Why Refer to Seaport Smiles?
Board-Certified Excellence
Dr. Ella Osborn brings expertise and precision to every case, ensuring optimal outcomes for your patients.
Collaborative Care
We maintain open communication throughout treatment, keeping you informed of your patient's progress.
Advanced Technology
State-of-the-art 3D imaging and digital treatment planning ensure precise, efficient care.
Direct Communication Preferred?
Feel free to call us directly to discuss a patient referral or if you have any questions about our services.