Online Referral Form
Secure Online Doctor Referral Form
You may refer patients to NRV Oral & Maxillofacial Surgery, Ltd. by filling out our secure online Referral Form. After you have completed the form, please make sure to press the Complete & Send button at the bottom to automatically send us your information. After you submit the form you will have the opportunity securely upload and transmit images of Patient X-rays.
The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it.
For assistance, please call our office: NRV Oral & Maxillofacial Surgery Blacksburg Office Phone Number 540-951-8777 (Blacksburg) or NRV Oral & Maxillofacial Surgery Radford Office Phone Number 540-633-5700 (Radford).