Our Locations:

DS of Maine

Portland Office
1355 Congress St
(207) 879-0011

Yarmouth Office
45 Forest Falls Dr.
(207) 846-0005

Biddeford Office
413 Alfred St.
(207) 571-4655

Patient Referral Form

To improve our service to you and to our patients, we have developed this online appointment request form.  For patient confidentiality, please omit the patient's full last name and use their last initial only. 

Please email the patient's records to reception@dsofmaine.com.

Thank you for your referral and we look forward to continuing to provide quality and reliable dental care. 

Service(s) Requested *








Tooth Number(s) *

































Call Before Treatment? *


Post Space?


Extract Tooth If It Can't Be Saved?


How Referrals Are Processed

Patient referrals are sent via email to our Patient Coordinator in the Portland, Maine office.  Based on your request, we will route the referral to the office requested or the soonest available doctor.  If your request is sent after business hours or over a weekend or holiday, it will not be received until the next business day.  Our computer systems are encrypted, however as this online system is new, we are taking the extra precaution of privacy by only asking for the patient's first initial of their last name to ensure HIPAA Privacy and Security compliance.  If you have any suggestions as to how we can improve this process, please send an email to jared@dsofmaine.com.  Thank you for your continued support.