Dentist Referrals

Dentist Referrals

When you refer a patient to Manchester Oral Surgery, rest assured we will take care of all your needs, from the finest oral surgical care to processing a patient’s insurance.

MOS Insurance Fact Sheet

  • MOS processes all forms of insurance with the exception of Medicare, Medicaid and Martin’s Point.
  • Patients CAN use their insurance for any covered procedure at Manchester Oral Surgery.
  • The MOS staff works directly with insurance providers and will process a patient’s claim. Patients provide their insurance information and MOS does the rest.

PDF Referral Form

We would be honored for you to refer patients to our office. You may do so by filling out our PDF Referral Form. After you have completed the form, please fax it to us at (603) 622-9738 or email it to The security and privacy of patient data is one of our primary concerns and we have taken every precaution to protect it.

Technical Note

Our online forms use the Adobe Acrobat Reader. Please download it free from Adobe’s website if it is not already installed on your system.