Step 4. Dietitian Referral

Nick returns to you 5 months later with additional tooth pain. Again, you notice he has been snacking on chips and is holding a bottle of green sports drink. Recently, you were speaking to a colleague who has started to refer his patients to a registered dietitian. After determining Nick will require additional restorative treatment, you decide he and his mother may benefit from more extensive nutritional counseling and decide to give the referral a try.

style="display:none"<% }%>> Referral Complete

Find a Registered Dietitian

Visit EatRight.org
Locate a dietitian by entering your zip code
Fill out a referral form with goals for Nick’s visit
Click Refer

Pediatric Dental Smiles
Referral Form

PATIENT
Name: Nick Williams
DOB: 03/12/2007
Gender: Male
Phone #: (817) 555-4444

Today's Date:

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Referring to:

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Referring dentist:

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Reason for referral:

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Medical History:

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