Thank You for Trusting Us with Your Referral!

Tooth Fairy Dental Care provides comprehensive pediatric dental services for children across . We’re proud to accept most insurance, including Medicaid!

We partner with providers to ensure infants, children, and teens – especially those with complex cases or special needs, receive high quality care.

Submit your referral below to get started.
Let’s improve access to care together.

Are you a Patient or Health Care Office/Doctor?*

Health Care Office/Doctor Patient
Your Info:
Your Full Name*

First Name Last Name
Your Phone*
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Your Email*
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Info for Person You are Referring:
Their Full Name *

First Name Last Name
Their Email*
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Their Phone*
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Referral Details / Information*
Doctor or Dentist Name*
Practice Name*
Practice Phone Number*
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Practice Email*
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Patient's Full name*

First Name Last Name
Patient Phone Number*
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Patient Email*
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Preferred Tooth Fairy Dental Care Location*
Reason for Referral*

Medicaid PatientIn Office General Anesthesia Routine Dental Care Requires Specialty Care Full Practice Other (please enter comments in additional details box below)
Additional Details/ Information
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