Referral Form

Thank you for choosing Liberty Endodontics. Your patients well-being and personalized care are our primary concerns. Our Office hours are Monday – Thursday from 8:00 AM until 5:00 PM.

Emergencies will be seen as needed on a stand-by basis and there are ALWAYS emergency appointment slots reserved for our top referring offices. Please contact the office directly if you have a patient in urgent need of treatment. All efforts will be made to see the patient as soon as possible. 

Please feel free to talk with Dr. Lask or any of our staff if you have any questions or concerns regarding the referral process. 

If you need more referral forms please email us at [email protected] or if you would like an electronic copy of the referral form please click below. 

Referral Form

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 Submit 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 System

Collaborator 3.0 Now Online To Better Manage Patient Care

Please CLICK HERE to submit a new referral or manage new patient cases with our new collaborator software.

This website will allow you to refer patients to our office and collaborate on case development. Due to stringent HIPAA requirements, you must have an individual user name and password to access this portion of our web site. For first time users, or if you have forgotten your password, please contact us to obtain your login info.