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.
  • Date Format: MM slash DD slash YYYY

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.

  • Date Format: MM slash DD slash YYYY

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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