If you’ve come here to refer a friend or family member, you’ve come to the right place.

Referring a Friend to Charles Regalado, DDS is as easy as 1-2-3…

Submit the contact details of your friend or family member using the form below.

Our office will reach out to them to schedule an appointment.

After they come in for their first appointment, we will email you a link to your $25 gift card!

(Fine print: To qualify for a referral reward, the person you refer must be a new patient.)

Name(Required)

First Name Last Name

Email(Required)

I'm referring my…(Required)

Friend

Family Member

Referral Name(Required)

First Name Last Name

Referral Phone Number(Required)

Referral Email

Reward Choice(Required)

CAPTCHA