SHARE A SMILE

Reward yourself with Shoe Orthodontics referral program! Having a thriving practice is all about our amazing patients. We are thankful for their confidence and trust in us to offer the complete orthodontic care they need. That’s why we are excited that you are considering recommending us to your family or friends.

REFERRAL RULES & REWARDS

When your referred friend or family member starts treatment, you will receive a $100 Visa Gift Card!

Please note the following:

Existing patients are not able to be “referred.”
The Share a Smile referral form must be completed before the referred patient comes in for a consult.
Patients within the same household may not be referred.
Referred patient must start active orthodontic treatment for referring person to receive a $100 Visa Gift Card.

Only 1 person can be listed as referrer. However, you can refer several people for the opportunity to receive multiple $100 Visa Gift Cards.

REFERRAL INFORMATION

Please note: Only 1 individual can be listed as a referrer, but you can receive multiple $100 Visa Gift Cards if several friends start treatment.

Your Name

Email Address

Name of patient you are referring

Their Email

Their Phone Number

Relationship to the patient

schedule appointment bg

SCHEDULE YOUR APPOINTMENT

Please complete and submit the form below and a member of our staff will contact you shortly.

Your Name

Phone Number

Email Address

Insurance provider

Preferred Appointment Date

Referred by

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Shoe Orthodontics

(Hanover, PA)

1191 Eichelberger St.

Hanover, PA 17331

(717) 634-2461

Shoe Orthodontics (Reisterstown, MD)

409 Main St.

Reisterstown, MD 21136

(410) 833-9330

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