Eric Blasingame, DDS, MS
Board Certified in Periodontology and Dental Implant Surgery
William Liska, DDS
Board Certified in Periodontology and Dental Implant Surgery
Nathan Antoine, DMD, MS
Board Eligible in Periodontology and Dental Implant Surgery
teamperiodontics.com
Redding 530.241.3302
Reno 775.447.1191
1
Patient Information
Imaging Provided

2
Evaluation For
Periodontal Concerns
Dental Implants
Oral Surgery
Sedation
My patient is interested in

If you need help with this form or want to see if your patient can be seen the same day, please call our office.
Redding: 530.241.3302 | Reno: 775.447.1191

Eric Blasingame DDS, MS
Board Certified in Periodontology and Dental Implant Surgery
William Liska DDS
Board Certified in Periodontology and Dental Implant Surgery
Nathan Antoine, DMD, MS
Board Eligible in Periodontology and Dental Implant Surgery
teamperiodontics.com
Redding 530.241.3302
Reno 775.447.1191
Redding

384 Hartnell Ave. Suite A.
Redding CA 96002

Phone: 530.241.3302

Reno

855 West 7th St. #130
Reno NV, 89503

Phone: 775.447.1191