Teledentistry

Teledentistrydante@rocketlocal.ai2025-03-21T13:14:35-04:00

Welcome to Teledentistry! Advise your patients about their needed treatment and have details of time, fees and procedures before arranging perio referral or recommending in-office treatment.

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Referring Doctor

Name*

First Last

Address*

Street Address City State / Province / Region ZIP / Postal Code

Email*

Phone*

Patient Info

Name*

First Last

Address*

Street Address City State / Province / Region ZIP / Postal Code

File

Max. file size: 64 MB.

File

Max. file size: 64 MB.

File

Max. file size: 64 MB.

File

Max. file size: 64 MB.

Product Name

Virtual Consultation Fee

Payment Method*

American Express

Discover

MasterCard

Visa

Maestro

Card Number Expiration Date Security Code Cardholder Name

Comments

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