For Referring Doctors | The Kids' Dentist

Referral Forms & Information

We welcome referrals from general dentists, pediatricians, orthodontists, and healthcare providers throughout the greater Portland metropolitan area. Submit your patient referral online below with digital X-rays and records, or download our printable form.

Submit Referral Online ↓ Download Referral PDF Form

Records and radiographs submitted through our secure online form are encrypted in transit and routed directly to Dr. Yip and our clinical coordinator.

How to Reach Us

Phone (503) 697-GRIN (4746)
Fax (503) 635-0035
Email grin@oregonkidsdentist.com
Address 18676 Willamette Dr. Ste. 301, West Linn, OR 97068

For urgent emergencies or peer-to-peer doctor consultations, please call our direct line for priority clinical coordination.

Secure Online Doctor Referral

Complete this form to refer a patient for pediatric dental care, behavior management, wisdom teeth extractions with IV sedation, or orthodontic evaluation.

🔒 TLS 1.3 Encrypted Submission

🏢 Referring Doctor & Practice Information

Referring Doctor / Practice Name *

Referral Coordinator / Contact Person

Office Phone Number *

Office Email Address *

👤 Patient & Family Information

Patient Name (First & Last) *

Date of Birth *

Age

Parent / Guardian Name *

Parent / Guardian Phone *

Parent / Guardian Email

Family Notification Status

📋 Reason for Referral & Specific Teeth

Specific Teeth or Quadrants Involved (Optional)

🧸 Patient Behavior & Sedation Needs

Anticipated Cooperation / Behavior Level

Sedation / Anesthesia Preference

📎 Radiographs & Diagnostic Attachments

Radiographs / Records Status

Attach Diagnostic Records, X-Rays, or Referral Letters:

📁

Drag & drop files here, or browse your computer

Supported formats: Panoramic & Bitewing X-rays, PDFs, DICOM (.dcm), ZIP archives, JPG/PNG, Word docs (Up to 25MB single / 30MB total)

🔒 HIPAA Security Notice: Attachments are encrypted in transit via TLS 1.3 and transmitted directly to Dr. Yip's secure clinical inbox.

📝 Clinical Notes & Medical History

Clinical Observations, Relevant Medical History, or Known Allergies

Collaborative Care Etiquette: Please return patient to our office for routine hygiene, cleanings, and ongoing recall care once specialized treatment is complete.

A confirmation will be displayed upon receipt. Our clinical coordinator will follow up with both your practice and the family promptly.

Now Accepting Referrals for Wisdom Teeth Extractions with IV Sedation

We partner with general dentists, orthodontists, and pediatricians across the Portland metropolitan area. Our practice contracts with an experienced dental surgeon who provides specialized care for in-office third molar extractions with intravenous (IV) sedation for adolescents and young adults. Our team ensures continuous hemodynamic monitoring, low surgical morbidity, and smooth post-operative communication with referring providers.

To refer a patient: complete the online form above, email panoramic X-rays and patient records to grin@oregonkidsdentist.com, or call (503) 697-GRIN.

Dr. Yip is a past president of the Clackamas Dental Society and serves on the medical staff of Legacy-Emanuel, Kaiser-Permanente, and Providence Hospitals.