Refer a Friend, Get a Gift Card

Were You Referred by Anyone?

If you were referred here by a patient or our practice fill out the form below and we'll make sure you AND the person who referred you get a $20 gift card in the mail!

OR, you can choose to have your account credited with $20 immediately. Gift cards will generally be issued within 3 months of your first appointment. Please specify your preference on the form below.

  • Must be a new patient
  • Must be at least 16 years old
  • Account must be in good standing to receive gift card
  • Other restrictions may apply

If you have already filled this form out, please scroll down to the "Didn't Receive Gift Card" section and submit that form instead!

  • Please do not fill this form out if you have already completed the referral section on your New Patient Form.

Didn't Receive Your Gift Card?

If you have not received your gift card within 3 months of your first appointment, possible reasons could include:

  • We have no record of your referral person as a patient in our office
  • You are younger than 16 years old
  • You have been seen in our office at some point in the past (not a NEW patient)
  • Your account is not in good standing (account must be at $0)
  • We are waiting for more gift cards to arrive
  • A clerical error

If you would like to be contacted about not receiving your gift card, please fill out the form below and we will contact you as soon as possible.

Contact Info

989 Langworthy St.
Dubuque, Iowa 52001

Phone: 563.583.2681

Fax: 563.583.6303

Email: info@langworthydental.com

Hours

Monday: 7:30 am - 5 pm

Tuesday: 7 am - 6 pm

Wednesday: 7 am - 6 pm

Thursday: 7 am - 2 pm

Friday: 8 am - 12 pm (Call First)

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