Referring Doctors

If you are a doctor referring a patient to our practice,
please fill out the following form.

Name:

Last Name:

Email:

Phone Number:

Patient's First Name:

Patient's Last Name:

Patient's Email:

Patient's Phone Number:

Last Exam Date:

Records:

FMX Pano Other

Other:

Delivery:

Additional Notes:

Contact us today to schedule your appointment.
We look forward to meeting you & seeing you smile!

Book Your Appointment Below

Office Hours

Monday: 11AM–2PM, 3:30–7:30PM*
Tuesday: 9AM–12PM, 1:30–5:30PM*
Wednesday: 7:30AM–12PM, 1:30–4PM*
Thursday: 9AM–12PM, 1:30–5:30PM*
Friday: Administrative Day*
Saturday: 8AM–2PM*
Open one Saturday per month.
Sunday: Closed

Our Address

I Song Orthodontics: Dr. Immi Song
1301 Solano Ave #101
Albany, CA 94706

Location

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