Referring Doctors

Doctors referring to Smile Gallery Orthodontics can complete the form below.

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Referring Doctor Information:

The form below can be used to supply doctor and patient information to Smile Gallery Orthodontics.

Referring Doctor(Required)

Doctor Name

Referring Doctor Phone(Required)

Patient Name(Required)

Patient Full Name

Date of Birth(Required)

Patient Phone(Required)

Reason for Referral(Required)

Date of Referral(Required)

Email

This field is for validation purposes and should be left unchanged.

Our Mission

Our orthodontic office provides outstanding orthodontic care to all of our patients. Our goal is to keep your smile healthy and bright. Our orthodontic professionals will answer any questions you may have about your treatments, and we will strive to make sure you and your family are comfortable during your entire visit to our office.

Excellence in Orthodontic Care for the Entire Family

Contact Us Today for an Appointment

Don’t wait, schedule your appointment with our friendly orthodontic team today and keep your smile healthy and bright.

Orthodontist Near You

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Address:

5080 N Lincoln Avenue
Lincoln Square, Chicago, IL 60625

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Hours

Monday: 11:00 AM - 7:00 PM*
Tuesday: 11:00 AM - 7:00 PM*
Wednesday: 11:00 AM - 7:00 PM*
Thursday: 11:00 AM - 7:00 PM*
Friday: 11:00 AM - 7:00 PM*
Saturday: 9:00 AM - 3:00 PM*
Sunday: Closed

*By Appointment Only

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Phone:

(312) 500-2022

Patient Reviews

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Frequently Asked Questions