If you would like to refer a patient to our office for endodontic care, please complete the above form and email (, fax (802-296-2012), or mail it to our office. If you would like to speak with one of our doctors prior to your patient's visit, please feel free to call our office at 802-295-7522.

We appreciate your considering Upper Valley Endodontics when your patients require endodontic care.