Dr. Robert C. Henry, DDS, MS  |  Smiles Inc. We're Making People Smile
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Smiles Inc.
4810 W. Loop 250 N.
Midland, TX 79707
phone: 432-682-1222
fax: 432-683-7412

Refer a Friend


A successful orthodontic practice doesn't just happen. It is the result of a strong commitment to excellence in orthodontics and in our relationships with patients and doctors. We'd like to take a moment to thank you for showing your confidence in our practice by recommending us to your friends, family and colleagues. We're gratified to find how many new patients regularly call on us based on your words of advice.

Doctor's Referral Form

If you are a doctor who is referring a patient to us, please fill out and submit the following form.

Today's Date:

Your Name:

Your Practice Name:

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Full Name of the Patient You Are Referring:

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Patient's Referral Form

If you are a patient of record who has referred a new patient to us, please let us know by filling out and submitting the following form.

Today's Date:

Your Name:

Your Telephone:

Your Email Address:

Full Name of the Patient You Have Referred to Us:

Comments:

Verification Code (case sensitive):

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