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Referrals

Submit a referral and upload records so our team can schedule a focused appointment without requiring a comprehensive exam first.

Step 1: Submit the secure referral form and upload records

Step 2: Our team reviews and contacts the patient within 1–2 business days

Step 3: We schedule the appropriate focused visit and coordinate care with your office

Referring Office Information

Preferred Contact Method

Patient Information

Patient Date of Birth
Month
Day
Year

Referral Details

Requested Appointment Type
Urgency

This form is secure and intended for professional referrals only.

Contact Us

859-618-6311 (call or text)

859-403-2000 (fax)

128 E Main St Midway, KY 40347

contactus@mfdky.com

Hours

Monday          

Tuesday             

Wednesday       

Thursday

Friday

Sat-Sun

Closed 1-2pm daily for lunch

8am-5pm

8am-5pm

closed

8am-5pm

8am-5pm

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© 2018 Rachel Riley DMD

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