{"id":2623,"date":"2020-07-29T18:24:11","date_gmt":"2020-07-29T22:24:11","guid":{"rendered":"https:\/\/www.ortho-tmj.com\/?page_id=2623"},"modified":"2024-04-29T16:06:07","modified_gmt":"2024-04-29T20:06:07","slug":"referral-form","status":"publish","type":"page","link":"https:\/\/www.ortho-tmj.com\/referral-form\/","title":{"rendered":"Referral Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2623\" class=\"elementor elementor-2623\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-1b2d916a elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"1b2d916a\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-77de845a\" data-id=\"77de845a\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-a29e857 elementor-section-content-middle elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"a29e857\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-10aa6cd\" data-id=\"10aa6cd\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-59e38dc elementor-widget elementor-widget-image\" data-id=\"59e38dc\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.21.0 - 25-04-2024 *\/\n.elementor-widget-image{text-align:center}.elementor-widget-image a{display:inline-block}.elementor-widget-image a img[src$=\".svg\"]{width:48px}.elementor-widget-image img{vertical-align:middle;display:inline-block}<\/style>\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"800\" height=\"842\" src=\"https:\/\/www.ortho-tmj.com\/wp-content\/uploads\/2024\/04\/Dr.-S-Dr.-R-973x1024.jpg\" class=\"attachment-large size-large wp-image-4592\" alt=\"\" srcset=\"https:\/\/www.ortho-tmj.com\/wp-content\/uploads\/2024\/04\/Dr.-S-Dr.-R-973x1024.jpg 973w, https:\/\/www.ortho-tmj.com\/wp-content\/uploads\/2024\/04\/Dr.-S-Dr.-R-285x300.jpg 285w, https:\/\/www.ortho-tmj.com\/wp-content\/uploads\/2024\/04\/Dr.-S-Dr.-R-768x809.jpg 768w, https:\/\/www.ortho-tmj.com\/wp-content\/uploads\/2024\/04\/Dr.-S-Dr.-R.jpg 1152w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-66 elementor-inner-column elementor-element elementor-element-7fd3eb6\" data-id=\"7fd3eb6\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-4fa524e elementor-widget elementor-widget-heading\" data-id=\"4fa524e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.21.0 - 25-04-2024 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h2 class=\"elementor-heading-title elementor-size-default\">We Appreciate Your Referral<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-348f0f1 elementor-widget elementor-widget-text-editor\" data-id=\"348f0f1\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.21.0 - 25-04-2024 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#69727d;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#69727d;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t<p>We value our referring physicians and are proud to partner with you in providing your patients excellent Orthodontic, TMD, Snoring and Sleep Apnea care! To refer a patient, simply complete the referral form and send it to contactus@ortho-tmj.com or fax it to 519-455-4779. We will send you a full report on each patient regarding our diagnosis and proposed treatment plan. Thank you for your referrals.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-021f1d5 elementor-widget elementor-widget-button\" data-id=\"021f1d5\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"https:\/\/www.ortho-tmj.com\/wp-content\/uploads\/2021\/11\/Patient-Referral-Form-FRONT-updated-2021-NEW_3.pdf\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-icon elementor-align-icon-left\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"far fa-file-pdf\"><\/i>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Referral Form<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>We Appreciate Your Referral We value our referring physicians and are proud to partner with you in providing your patients excellent Orthodontic, TMD, Snoring and Sleep Apnea care! To refer a patient, simply complete the referral form and send it to contactus@ortho-tmj.com or fax it to 519-455-4779. We will send you a full report on [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Referral Form - Dr. Brock Rondeau &amp; Associates<\/title>\n<meta name=\"description\" content=\"Referring Doctors - please access a referral forms here. We look forward to the opportunity to care for your patient. Questions? 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