Referring Doctors

For your convenience, you may use our online referral form to submit your patient's information. If you would prefer, a link to a printable version of this form that you can download, fill out and send to our office is below.

Printable forms should be mailed to:

Oubre Orthodontics
1605 Kaliste Saloom Rd.
Lafayette, LA 70508

Thank you in advance for your referral.

Doctor Referral -
Phone Type

Patient & Contact Information

Phone Type
What are your primary concerns regarding this patient? (check all that apply)
Any additional dental problems? (check all that apply)
Are any of the following radiographs available to be sent? (check all that apply)

The information that I have given above is correct to the best of my knowledge.

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Oubre Orthodontics

  • Oubre Orthodontics - 1605 Kaliste Saloom Rd., Lafayette, LA 70508 Phone: 337-988-2025

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