Referral Program

  • Want to extend the same great services you receive at ACDG to friends and family? If so, we would like to thank you for your loyalty and support.  Please come complete the following information so that we may extend our gratitude. 

    • Your Name:

    • Phone:

    • Individual Referred (Full Name):


  • Program Details:*

    • One Referral: One Complimentary Fluoride Treatment on your next visit

    • Two Referrals: One  Complimentary Cleaning

    • Three Referrals: $50 Gift Card of your choice