Refer a Friend

A successful practice doesn’t just happen. It is the result of a strong commitment to excellence in our treatment 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.

We want to thank you again for choosing Benson Hill Smiles. Patients like you are the reason we love what we do. That is why we would like to share our loyalty program with you.

For every new patient you send our way we would like to thank you by sending a gift card from one of our favorite business.*

There’s no limit on how many gift cards you can receive.

Patient 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.

  • Please do not submit any Protected Health Information (PHI). This is not a secure or encrypted means of communicating with our dentist office.
  • This field is for validation purposes and should be left unchanged.

We Look Forward To Seeing You!

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