Refer a Patient to Coastal Kids Dental & Braces

Referring a patient to Coastal Kids reflects the trust and confidence our community has in our services. We’re proud to work with other local healthcare providers and community resources to connect families with pediatric dental care throughout the Charleston area. We also accept referrals of friends and family members of our current patients.

We’re grateful for the trust that patients, fellow healthcare providers, and our community partners place in our team. We take that trust seriously and strive to provide the best possible care to everyone we welcome through our doors. If you would like to refer a patient to our office, please fill out the form below or contact our office to provide the information we need to get an appointment scheduled.

If you would like to make a referral for orthodontic treatment, please visit our partners at Coastal Family Orthodontics.

"*" indicates required fields

Patient Name*

Patient Date of Birth*

Name of Parent or Legal Guardian

Patient or Guardian Phone Number*

Patient or Guardian Email Address

Referring Doctor Name*

Referring Doctor Phone Number*

Referring Doctor Email Address

Preferred Location*

Comments or Notes

CAPTCHA

Comments

This field is for validation purposes and should be left unchanged.