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Please fill out the form below and we will answer it as soon as possible. Information submitted from this form will be kept on file for future reference.

Download a PDF version of our Referral Form here. You can fax it into our office at 506-858-1397.

Requested Doctor:	Dr. McManaman      Dr. Porter      Dr. Clifford
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*Preferred Form of Contact:	Home Phone      E-Mail      Cell Phone
Do you have orthodontic insurance?	Yes      No      Not Sure
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