Comfort Family Dental

Richard M. Schwarcz, DDS ■ 25529 Van Dyke Ave. ■ Center Line, MI 48015 ■ 586-757-3373

Refer a Friend

Map and Directions | Comment Form | Refer a Friend

A successful dental practice doesn't just happen. It is the result of a strong commitment to excellence in dental care and in our relationships with patients and doctors. At Comfort Family Dental we appreciate your confidence in us and believe the greatest compliment you can give is a referring your friends and family to our office. Our referral program is called Care to Share. If you refer a new patient to our office you will receive a $25 gift card to local merchants and restaurants. This is our way to thank you for your support. We're gratified to find how many new patients regularly call on us based on your words of advice.

Choose a form:

» Patient Referral
» Doctor Referral

Doctor Referral Form

If you are a doctor who is referring a patient to us, please fill out and submit the following form.

Your Information:

Your Name:

First

Last
Your Practice Name:

Full Practice Name
Email Address

Valid Email Address

Referral Information:

Name of Person You're Referring:

First

Last
Were Radiographs Sent?

Yes No

When were they sent?
Additional Information:

Comments:

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Comfort Family Dental

Refer a Friend

Choose a form:

Your Name:

Your Practice Name:

Email Address

Name of Person You're Referring:

Were Radiographs Sent?

Additional Information:

For Security Purposes, Please Enter the Code Below: