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Patient Referral Form
Sonia Chopra, DDS
Mark Tadrissi, DDS
Tanya Reiter, DDS
Please fill out the form below to refer a patient to our office. After submitting the form, you will be able to save a summary of the referral and directions to our office.
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Patient Information
*First Name
*Last Name
*Date of Birth
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Email
*Phone
 
Referring Doctor Information
*First Name
*Last Name
Email
*Phone
Teeth Needing Treatment
Teeth Needing Treatment
 
 
 
Requested Treatment
Restoration
Comments / Special Instructions
Office Map & Directions
From Indian Land/Lancaster:
Take Hwy 521 North toward Charlotte. At the intersection of Johnston Road and Ballantyne Commons Parkway turn Left. Once on Ballantyne Commons Parkway, at the 1st Light turn Right on to Ballantyne Medical Plaza. Then, make the 1st Left by the Blue Sign that says “Ballantyne Medical Two.” Drive straight to back of the parking lot toward the HARPER BUILDING (purple flags). Ballantyne Endodontics is located on the 2nd floor of the Harper Building. 14135 Ballantyne Corporate Place Suite 215.

From Blakeney:
Turn Left on to Rea Road at the Light near Target (CVS and McDonald’s will be on the right, and the Marathon Gas Station will be on the left). Continue on Rea Road. At the intersection of Rea Road and Ballantyne Commons Parkway, make a Left. Please Follow the below directions From Rea Road.

From Rea Road:
Turn on to Ballantyne Commons Parkway toward Johnston Road. Drive through the Johnston Road and Ballantyne Commons Parkway intersection. Turn Right on to Ballantyne Medical Plaza. Then, make the 1st Left by the Blue Sign that says “Ballantyne Medical Two.” Drive straight to back of the parking lot toward the HARPER BUILDING (purple flags). Ballantyne Endodontics is located on the 2nd floor of the Harper Building. 14135 Ballantyne Corporate Place Suite 215.
From I-77 S or I-85 S toward Pineville:
Take I-77 or I-85 to I-485 East (Outer Loop) toward Pineville. Please follow the directions below From I-485 East/Pineville (Outer Loop)

From I-485 East/Pineville (Outer Loop):
Take Exit 61 toward Johnston Road/Hwy 521 and bear Right off the exit ramp heading south down Johnston Road/Hwy 521. Turn Right on to Ballantyne Commons Parkway at the 2nd Light after exiting the highway. Once on Ballantyne Commons Parkway, at the 1st Light turn Right on to Ballantyne Medical Plaza. Then, make the 1st Left by the Blue Sign that says “Ballantyne Medical Two.” Drive straight to back of the parking lot toward the HARPER BUILDING (purple flags). Ballantyne Endodontics is located on the 2nd floor of the Harper Building. 14135 Ballantyne Corporate Place Suite 215.

From I-485 West/Matthews (Inner Loop):
Take I-485 West toward Pineville. Take exit 61B toward Johnston Road South/Hwy 521. Merge Left once off the exit ramp. Turn Right on to Ballantyne Commons Parkway at the 3rd light after exiting the highway. Once on Ballantyne Commons Parkway, turn Right at the 1st Light on to Ballantyne Medical Plaza. Then, make the 1st Left by the Blue Sign that says “Ballantyne Medical Two.” Drive straight to back of the parking lot toward the HARPER BUILDING (purple flags). Ballantyne Endodontics is located on the 2nd floor of the Harper Building. 14135 Ballantyne Corporate Place Suite 215.
Harper Building • 14135 Ballantyne Corporate Place • Suite 215
Charlotte, NC 28277  Tel (704) 541-7017  Fax (704) 541-7019

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BALLANTYNE ENDODONTICS
14135 Ballantyne Corporate Place, Suite 215
Charlotte, NC 28277
Serving the Charlotte, NC Metro area Se Habla Español.
14135 Ballantyne Corporate Place, Suite 215
Charlotte, NC 28227
Phone:
(704) 541-7017
Fax:
(704) 541-7019

www.ballantyneendo.com
Serving the Charlotte, NC Metro area
Se Habla Español.
BALLANTYNE ENDODONTICS
14135 Ballantyne Corporate Place, Suite 215
Charlotte, NC 28277