Physicians who wish to refer a patient to Emory Oral and Maxillofacial Surgery may do so by filling out the form below and pressing the Submit button to automatically send the patient's information to our office.

There is a downloadable Referral Form (PDF 131Kb) that can be printed and either faxed or mailed to our office. The mailing address and fax number are as follows:

Emory Oral and Maxillofacial Surgery
1365 Clifton Rd. NE
Building B, Suite 2300
Atlanta, GA 30322

Fax: 404-778-5879

As always, the referring physician or the patient is welcome to contact our office directly at 404-778-4500 in order to schedule an appointment.

*Required Fields

Patient Information



Format: XXX-XXX-XXXX
Format: XXX-XXX-XXXX

Doctor’s Information



Format: XXX-XXX-XXXX