Home
Dr. Durbin
Dr. Douglas Durbin
Mission and Vision
Our 7 Locations
Lexington
Georgetown
Winchester
Mount Sterling / Owingsville
Richmond
Nicholasville
Boynton Beach, FL
Services
Virtual Appointments
Convenience Invisalign
Clear Aligners
Invisalign®
Orthodontic Services
Traditional Braces
Surgical Procedures
What is the Right Age?
ACCELEDENT® OPTIMA™
Smile Gallery
Reviews
Miss Kentucky Testimonial
Patient Education
Welcome Video
Educational Videos
Blog
Invisalign Instructions
Frequently Asked Questions
Oral Hygiene
Glossary of Orthodontic Terms
No-No Food List
Waterpik
Mouthguard Instructions
Dr. Durbin's Retainer Research
New Patients
Health History Form
Financing
My Old Kentucky Home
K-12 Appointment Policy
New Patient Referral
Doctor Referral
Contact
860 Corporate Drive Suite 201,
Lexington,
KY
40503
859-279-4450
200 Bevins Lane Suite F,
Georgetown,
KY
40324
502-276-9676
Home
Friend and Family Referral
Friend and Family Referral Form
Full Name
Email Address
Phone Number
Today's Date
Family or Friend's Name (First and Last)
Contact or Responsible Party (if minor):
Family or Friend's Phone Number:
Reason for Referral
General Orthodontic Evaluation
General Orthodontic Evaluation
Crowding
Crowding
Spacing
Spacing
Harmful Habits
Harmful Habits
Openbite
Openbite
Overbite
Overbite
Overjet
Overjet
Underbite/Crossbite
Underbite/Crossbite
TMJ Dysfunction
TMJ Dysfunction
Submit