Referral Form

Fill in the fields on the form by using the tab key to move from field to field. When you have completed the form, click on the SUBMIT FORM button at the bottom of the page. You will have the option to upload up to 5 x-ray images.

Contact POMS Facial Surgery


The first step towards a beautiful, healthy smile is to schedule an appointment. Our scheduling coordinator will contact you to confirm your appointment. If you are an existing patient, this contact form should not be used to communicate private health information.

Our Locations

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Raleigh

Hours

Mon:
Tue:
Wed:
Thu:
Fri:

9am - 5pm
9am - 5pm
9am - 5pm
9am - 5pm
8am - 1pm

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Elizabeth City

Hours

Mon:
Tue:
Wed:
Thu:
Fri:

9am - 5pm
9am - 5pm
9am - 5pm
9am - 5pm
8am - 1pm