Online Referral Form

You may refer patients to our office by filling out our secure online Referral Form. After you have completed the form, please make sure to press the Complete and Send button at the bottom to automatically send us your information. The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it.

Online Referral Form

We're Here To Help

Call our Gastonia office at Carolina Oral & Maxillofacial Surgery Phone Number 704-865-0081 with any questions or to schedule a consultation with Dr. Eaton. Or you can use our online form