Online Referral Form

To Our Referring Pediatricians, Dentists and Healthcare Professionals:

For your convenience, BrightSmiles Pediatric Dentistry can provide your office with referral pads. Just call 7732718400 ext 4330 or email us at and we will be happy to drop off a referral pad.

We welcome referrals from Chicago and surrounding suburbs. BrightSmiles Pediatric Dentistry has special fast-track emergency appointments available for your referral patients and we will do our very best to provide your patients with excellent and very timely pediatric dental care.

Thank you very much!


Click here to visit our other office, Baby Tooth Surgeons.