Dr. Name
Office address
City, State ZIP
(or preferably print on letterhead)

Date

Dr. Periodontist
Address
City, State  Zip

Dear Dr. Periodontist:

I have referred [patient name] to you for crown lengthening surgery around #19.  I am sending bitewings and a periapical from 8/13/96.

Jane was a new patient to us last week.  She was a previous patient of [Dr. _____].  She has a good dentition; #19 build-up and crown is the only restorative work we have planned.  I did note generalized gingivitis, but the pocket probings were good.

She remembers being advised of having the caries on #19 treated after she had her baby 2 years ago, but she never followed through with treatment.

I have referred her to [Dr. Endo] for endodontic treatment of 19, and will steer her your way after completion of the root canal work.

Let me know if you need any more information.

Sincerely,

Dr. _______