Doctor Referral Form

Thank you for your confidence and trust in our practice. We sincerely appreciate your patient referrals and value our professional relationship. 


If your office is in need of referral pads please call 614-751-7500 to place your request and we will gladly get them to you.

For your convenience please email x-rays to

To download the Pickerington Manor Jaw & Facial Surgery referral slip please click here.
To download the New Albany Jaw & Facial Surgery referral slip please click 
To download the Bexley Jaw & Facial Surgery referral slip please click here.

Top 10 Reasons to Refer to Dr. Bath's Practice

1. Dr. Bath has accumulated more than 17 years in the OMS profession and experience with greater than 30 distinct implant systems.

2. Every patient enjoys professional, high quality care in a friendly and comfortable environment. Our motto is "Your Patient's Comfort is our Concern." (Check out our patient testimonials under the Patient Information tab).

3. Dr. Bath offers continuing education courses to referring doctors and their staff throughout the year. Convenient "Lunch and Learns" held in your office are a popular option! Additionally, doctors and staff are welcome to observe surgeries and other procedures.

4. Our office is a beautiful state-of-the-art facility equipped with the latest, most advanced technology including Radio Frequency and Piezo surgical devices, a Cone Beam CT Scanner and CO2/Alexandrite/Yag lasers.

5. Our Professional Relations Coordinator is available specifically for your convenience. We make every effort to communicate with referring offices regarding a patient's treatment and value referral feedback as a source to better serve your patients.

6. Dr. Bath hosts a variety of educational and social gatherings throughout the year to thank our referring doctors and teams.

7. We offer patient hours five days a week from 8am - 5pm. After hours, Dr. Bath is easily accessible via cell phone. Your emergencies are always welcome.

8. We pamper our referring office with monthly contests. Our contests promote friendly and spirited competition for a variety of prizes!

9. We help patients maximize their dental and medical benefits while offering a variety of payment options. Implant consultations including a panoramic x-ray are available to no cost.

10. Dr. Bath personally calls every patient following surgery to check on their recovery and answer any questions that might arise.