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About ADG
Dr. Lalama
Dr. Bak
Dr. Lozano
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Patient Referral
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Our Services
About Us
About ADG
Dr. Lalama
Dr. Bak
Dr. Lozano
Contact Us
Patients
Request an Appointment
Patient Referral
Patient Referral
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Patient's Name
Patient's Email Address
Patient's Phone Number
Should ADG call the patient to schedule?
Yes
No
Referring Doctor's Name
Referring Doctor's Phone Number
Reason for Referral
Are Radiographs Available?
Yes
No
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Please welcome Dr. Bak to our practice!
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