Refer a patient to us by downloading our Referral Form and sending to our office.
Download Referral Form PDF from the list below:
Directions for Forms:
- Fill out form using your computer
- Save completed form to your desktop
- Email as an attachment to preferred office
Alternatively, download PDF, print and fill out by hand, and mail or fax to preferred office.
Huntley Oral & Maxillofacial Surgery
Doctors Conlon, Bruksch, Ozment, Richard, Fay and Schmidt
11650 S. Route 47
Huntley, IL 60142
Monday – Friday 8:00 am – 5:00 pm
Saturday 8:00 am – noon
Hours may vary occasionally due to hospital surgery and emergencies.