Oral & Maxillofacial Surgery
1510 Medical Center Drive
Wilmington, NC 28401
© 2018 Dr. Gregg Lombardo
Referral Form (PDF)
This time is reserved spedfically for you. If by necessity, you must cancel your appointment, please notify us at least one day in advance.
(Please indicate below)
Expose & Bond
Will Bring X-ray
Given to Patient
INSTRUCTIONS TO PATIENTS
You have been referred for specialized care to an oral and maxillofacial Surgeon. Our office will make every effort to make your visit with us a comfortable experience. Please assist us by providing the following information at the time of your consultation.
Your surgical referral slip and any radiographs if available.
A list of medications you are presently taking.
Please bring your medical and dental insurance information with you.
Fees for office visits and x-rays and treatment will be due at the time of service, even if we are filing insurance for you.
A pre-operative consultation and examination are necessary for all patients.
All patients under the age of 18 must be accompanied by a parent or legal guardian at the consultation visit.
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