Call for free sedation or implant consultation: 402.397.7827
Text Message us now 402.740.9235 or email Dr. Starkey-- mike@stardds.com

Anesthesia Surgery Center

402.926.4848
Pain? Broken or lost teeth? Call us in AM we can usually get you in the same day. 402.397.7827

Referral  Request Form

For IV/ N20-02 Anesthesia Dentistrhy

Patient Name_________________________________________Date_________

Referring Doctor______________________________________Phone___________

Reason(s) for referral?

  • Gag reflex
  • Difficulty getting numb
  • Anxiety
  • Phobia
  • Needs both teeth and implants in one visit
  • Neurological ( Palsey, Tremors, Huntington's, Parkinsons, other)
  • Physical-e.g. neck, back, difficulty opening mouth
  • Older patient
  • Additional monitoring and IV line in place for safety precaution
  • Cardiovascular, pulmonary
  • Diabetic complications
  • Ambulatory problems
  • Other:


Treatment requests/special instructions:





Michael A. Starkey, DDS

7618 Dodge Street

Omaha, Ne 68114

402.926.4848

mikestarkeydds@gmail.com

Email mike@stardds.com Phone 402.926.4848 Text 402.740.9235







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Call us at 402.926.4848 for your next cleaning and check up

      Master, College of Conscious Sedation American Dental Society of Anesthesiology           


The Omaha Dental

 


              

 

​​      

Specializing in Comprehensive Dentistry

​ With Dental Sedation that fits your needs.

The Sweet Dreams Dental Team

Michael A. Starkey, DDS And Associates​​​​




Benefits of our Sedation Dental Center
Dental Implants, bone grafting, teeth in a day, mini implants, dentures