sCOVID-19: WE ARE OPEN AND SEEING PATIENTS. We are taking all precautions to limit the spread of this virus.

ORAL PATHOLOGY

Referral Form

Please note: Dr. Carl Allen sees patients in consultation only. He does not perform biopsies. If you schedule with him, and the patient needs a biopsy, the patient will have to reschedule with Dr. Ashleigh Briody for this procedure.

Please fill out the form below or download the referral sheet and fax to (614)794-4294



    Patient Birth Date:

     




    (Please provide a copy of medical insurance card, front and back. Please note that COSC is not a provider for any Medicaid.)


     

    Referral Information

     

    Referring Physician Information


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