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For referring doctors

A faster path from referral to coordinated care.

Send a referral straight to the front desk with the online form below — the referral card on the page fills in as you type. A blank referral slip is also available to print for offices that prefer paper.

Clinical imaging technology at Village Pointe Oral Surgery

Online referral form

Complete the form below and submit it to our front desk. You can attach X-rays right here, or email them to the front desk at frontdesk@vpoms.com so imaging is on file before the consultation.

Referring office

10 digits

Patient

10 digits

Referral details

Procedures

Scheduling
X-rays

You can attach more than one file — JPG, up to 20 MB total. For a full CBCT study or larger files, use the secure large-file upload below the form.

Notes

Have a full CBCT study or other large files?

They won’t fit this form’s 20 MB limit — send them through our secure upload instead. They go straight to the front desk.

Send large files securely

Printable blank copy

Prefer paper?

For offices that prefer paper, preview the front of the slip below, then open the blank PDF to print and fill in by hand.

Front of the Village Pointe Oral Surgery referral slip
Front

Print a blank referral slip (PDF)

Doctor-to-doctor contact

For urgent cases or a clinical discussion, call 402-317-5657 and ask to speak with the surgical team. Office hours:
Monday: 8:00 a.m.–5:00 p.m.
Tuesday: 8:00 a.m.–5:00 p.m.
Wednesday: 8:00 a.m.–5:00 p.m.
Thursday: 8:00 a.m.–5:00 p.m.
Friday: 7:00 a.m.–2:00 p.m.

Sending X-rays

Attach X-rays to the online referral form above, or email X-rays and referral records to the front desk at frontdesk@vpoms.com so imaging is on file before the consultation. For a full CBCT study or other large files:

Send large files securely

Fast report-back

The practice coordinates with the referring office and returns findings and treatment updates promptly after the patient is evaluated or treated. Include the preferred contact method so the report can reach the right person quickly.

Complete referral information

Patient contact details, the clinical concern, urgency, relevant history, and current imaging help the team triage the case and prepare for the consultation.

Send it online. Use the online referral form above.

Questions or next steps

Talk with the team.

Call the office for scheduling, procedure-specific guidance, or urgent postoperative concerns.

Call Now Request a Consultation

Village Pointe Oral Surgery

Call the office

Monday: 8:00 a.m.–5:00 p.m.
Tuesday: 8:00 a.m.–5:00 p.m.
Wednesday: 8:00 a.m.–5:00 p.m.
Thursday: 8:00 a.m.–5:00 p.m.
Friday: 7:00 a.m.–2:00 p.m.

402-317-5657
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Village Pointe Oral Surgery

Email the front desk

Choose your email app, or copy the address and paste it into a new message.

frontdesk@vpoms.com
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Ask the team

How can we help?

Send us a general question and the front desk will get back to you during office hours.

Please keep it to general questions — if the team needs more detail, they will call you. For urgent postoperative concerns, please call the office directly at (402) 317-5657 rather than using this form.