Patient Referrals

Charitable Giving Campaign

Dr. Sierakowski and the team believe in giving back to our local community. That’s why we’re excited to announce a New Patient Charitable Giving Campaign that will allow new patients to partner with us in giving back.

New patients who are referred by current or former patients can simply donate $50 to one of the charities below, and receive a periodontal or implant exam and digital x-rays free of charge, a value of $342.

Here’s how it works:

Get a referral from one of our current or former patients. At the time of your appointment, simply bring a check for $50 or more made out to one of the charities on our list below. We bundle the checks for each charity and send them out at the end of the month. Since you wrote the check directly to the charity, you’ll receive a receipt directly from the charity, which can be used as a charitable tax deduction. To thank you for your donation, you’ll get a complimentary periodontal examination and x-rays.

We partner with the following local charities:

To participate, just download the form below and bring it into your initial appointment.

Charitable Giving Campaign New Patient Referral Form