PATIENT REFERRAL FORM






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    Instructions For First Visit

    Relax! Our offices are no judgement zones. We will make you feel comfortable throughout your procedure.

    Please bring the following to your appointment:

    • Referral slip
    • Any x-ray your dentist has given you
    • Medication list
    • Photo ID
    • Dental insurance
    • Parent or legal guardian if you are under 18 years of age

    Please provide us with 48 hours notice if you need to change your appointment time.





    Contact Us Today

    Make an appointment, plan your visit, or get information from our knowledgeable staff using the info below.


    SCHEDULE YOUR APPOINTMENT

    Call Us Today!
    (865) 637-5708



    VISIT US

    303 S. Concord
    Suite 323
    Knoxville, TN 37919



    Premier Dental Group PLLC of Knoxville respects your privacy and takes the protection of personal information very seriously. Our Privacy Policy has been updated to reflect our use of your mobile phone number, which we collect with your explicit consent. We use your number exclusively for sending SMS messages related to appointment reminders, updates, and occasional offers. We ensure that these messages are sent in compliance with your preferences and consent. Your number is stored securely and will never be shared with third parties for marketing purposes without your explicit consent. You can withdraw your consent at any time by contacting us or replying STOP to any message.

    By submitting your phone number, you consent to receive SMS messages from Premier Dental Group PLLC of Knoxville for appointment reminders, updates, and occasional offers. You understand that message frequency varies, and you can opt-out at any time by replying STOP.


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