Norton Dentist         Katherine I Raymond DDS        Sedation Dentistry
Medina Sedation Dentist

Katherine I Raymond DDS
General Dentist

      
4322 Cleveland Massillon Road = Norton = OH 44203 = (877) 793-8492
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Please use the form below to enter the pertinent information your professional referral to our practice.
 
PATIENT DATA
Date:  
Time:  
Patient's Title:  
Patient's First Name:  
Patient's Last Name:  
Referred By:  
Telephone:  
Tooth #s:  
 

REASON FOR REFERRAL:

 Gag Reflex
    Dental Phobic
    Needle Phobic
    Noise Phobic
    Odor Phobic
    Difficult Anesthesia
    One Visit Dentistry
    Sensitive Teeth
    Patient Will Explain
 
Please include digital radiograph by pressing the browse button and locating the image on your hard drive:
 
COMMENTS
 
   
 

Dentist
Located in Norton Ohio and serving the surrounding
Fairlawn - Medina - Canton - Akron OH areas.


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Dr. Raymond is licensed to perform all listed services as a general dentist.  This provider is not a specialist in
sedation, tmj, cosmetic, prosthodontics, orthodontics, endodontics, whitening, implants and non-specialty
interest areas that require no specific educational training to advertise this service.

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