Referring to Progressive Periodontics

Here at Progressive Periodontics in Tigard, Oregon, we are please to provide exceptional care to each and every one of our patients. We are grateful for the trust you instill in us as a practice when you refer one of your valued patients. We will gladly offer your patient the same, quality care that you provide them in your office.

Use our secure referral form below to send us the necessary information for your patient. If you have any radiographs, or would prefer to send us the patient's information directly, you can email us at info@myperiopro.com. If you have any questions or need assistance, please call us directly at the office.

Just looking for a blank referral form? Click below to download a copy.

Referral Form

Patient Information





Insurance Information



Referral Information




Referral Tips


Scheduling Your Patient

In order to best serve your patient, we suggest scheduling them with our office as they are finishing their visit with you. This creates a simple, worry free process for the patient and allows us to offer them the best appointment option.


Completing the Referral Form

The referral form is a helpful item for both Dr. Thanik and our team. It gives us the opportunity to properly prepare for your patient's visit with us to ensure that we can offer them a thorough exam. We ask that you fill out all pertinent information on the referral form. If a question does not apply, feel free to skip it. We are grateful that you take the time out of your busy schedule to provide us with this helpful information.


Sending Over Patient Information

We kindly request that you share any pertinent patient information with us prior to their scheduled visit. This includes the following: Patient Name, Date of Birth, Contact Information and Insurance Information. In addition to patient information, we also ask that you share the completed referral form and any radiographs. This ensures that we are adequately prepared to care for your patient.
You can send any digital information to our email address, info@myperiopro.com. If you have physical copies, feel free to fax them to us at 503.924.6507


Do you have additional questions? Give us a call at the office!