Updated Patient Referral Form

February 25, 2025

Added updated patient referral form to the Forms page. This is for use by other dentists, doctors or practices to refer a patient to ToothFillers. Please download the form complete the field and provide to the patient you are referring to us. Please ask the patient to give the form to our front desk when making an appointment.

You can also download the patient referral from directly here.

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Office Hours

Monday & Tuesday: 7:00AM to 3:30PM
Thursday to Saturday: 7:00AM to 3:30PM
Wednesday & Sunday: Closed

Address

2593 South King Rd, Suite #3, San Jose, CA 95122

E-mail address

Phone

(408) 345-5660 (call and text),
(669) 275-2060 (call only)
(408) 345-5609 (call only)