About us
What is Endodontics?
What is an Endodontist?
Dr. Rechenberg
Services
Procedures
Root Canal Treatment
Root Canal Retreatment
Endodontic Surgery
Advanced Diagnostics
Emergency Care
Traumatic Dental Injury
Related Procedures
Technology
Surgical Microscopes
3D Radiography (CBCT Scan)
Digital Imaging
Good to Know
Patient Information
First Visit
Root Canal Treatment
Before Endodontic Treatment
After Endodontic Treatment
Surgical Treatment
Before Surgical Treatment
After Surgical Treatment
Referring Doctors
Why Refer to Us?
How to Refer?
Business Cards
Contact
DE
Referral form
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
Practice
Medical practice
Dentist
Street, no.
Phone
ZIP code, city
E-mail
Patient
Surname, first name
Date of birth
DD
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
MM
1
2
3
4
5
6
7
8
9
10
11
12
YYYY
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Street, no.
Phone
ZIP code, city
E-mail
Desired treatment
Tooth/Teeth/Region
Transfer for
Diagnostics/consulting
Microsurgical apicoectomy
Root canal treatment
3D imaging (DVT)
Root canal treatment revision
Other therapies
Other therapies
Comment on the treatment
Need for treatment
*
Normal
Urgent*
*In case of high acute/emergency please also contact us by phone.
Would you like a phone consultation before starting treatment?
Yes
No
Post-endodontic care
Access cavity closure
Situational, when appropriate
Definitive adhesive closure
Temporary closure
Remarks on post-endodontic treatment
Root post insertion
Yes
No
Yes, when appropriate
Transmission of enclosures
For data protection reasons, please send all enclosures, X-ray images etc. via
endo-zuerich@sso-hin.ch
.
Transmission of enclosures
*
by encrypted e-mail
with patient
no enclosures available
Consent for sending forms
*
I accept the
privacy policy
and agree that the data entered will be used for processing and sent as an e-mail confirmation.
Send
