Referral Form

No one wants to waste time in a waiting room filling out paperwork. That’s why Salaita Orthodontics allows our patients to get forms out of the way before they even step foot in the office. To save time, please complete the necessary form below and safely submit it online. Or if you would prefer, you may print them off and bring them with you!

Thank You for Your Referral!

Thank you for the trust you place in our practice when referring your patients — we value the opportunity to care for them. To begin a referral, request a second opinion, or schedule a consultation, please download and complete the referral form. To send electronically, please send the completed form to info@westervillebraces.com.

Referral Form

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What Sets Us Apart?

We’re not your typical orthodontics team. At Salaita Orthodontics, we are passionate about getting our patients excited about their visits with us. It’s essential for patients to participate in their treatment to make it a success, and our compassionate staff helps make it happen.

Get To Know Dr. Salaita

How can we help you?

Contact Us Anytime

Are you ready to start your orthodontic journey? We want to hear from you. Reach out here on our website to get your questions answered, schedule an appointment, or even start a virtual consultation.