REFERRAL TO ENDODONTIST
GAYLE OBERMAYR, DDS, MS
DENTAL SPECIALIST IN SAVING TEETH
Root Canal Therapy and Microsurgery with Comfort and Excellence
To be completed by Referring Doctor (check all that apply)
Consultation and Treat as Needed
Consultation for Treatment Planning
Consultation - This Tooth had Previous Root Canal Treatment
Build Up / Chamber Retained
Root Canal Therapy
Temporary Restoration of Access Opening
Permanent Restoration of Access Opening
Cement Post
Post Space Only
Post and Build Up
Notes:
Patient: Please bring this paper with you to your appointment.
Dr. Gayle Obermayr has 30 years of experience in dentistry. She earned her Dental Degree in 1987 from the University of North Carolina, and MS-Masters Degree in Endodontics at the University of Iowa in 1989. She has been specializing in performing root canals with comfort and excellence for 20+ years. She served as director of the DATS dental school for 5 years. She is a current member of many dental organizations such as FAE, AAE, HCDS, WCDS and ACD. She is a past president of both the Florida Association of Endodontists and the Southern Endodontic Study Group.
863-382-9947 • www.HeartlandEndodontics.com
4660 Lakeview Drive • Sebring, FL 33870-2063
Office is located on the West side of Lakeview Dr., North of Heartland National Bank