Dental Provider Referrals

If you’re a health-care provider and would like to refer one of your patients to us, please fill out the form below.

Make sure to attach any radiographs using the document uploader.

Provider Referral Form

  • Drop files here or
    Please only submit documents with the following extension types: .pdf, .jpg. .jpeg, .png, .doc, .docx

Still Have Some Questions?

We have the answers. If you can’t find what you’re looking for on this page, we recommend the following:

Contact Us
Call (904) 372-3260 or email the BeanTeam.
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Use the chat function at the bottom right to live chat with the BeanTeam.
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