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Refer A Friend
 

To refer a friend fill out the information below.

  • An Email will be sent to the address you have provided.
  • We will contact your friend if they respond saying that they would like more information about our office.
  • Thank you for recommending us to your friend
 
  *Friend's first name:
 *Friend's last name:
  
 

Friend's phone number:

  
 

*Friend's email address:

  
  *Your first name:
 *Your last name:
  
  *Your email address:
  
  Notes:
  
  * Required field  
         
 

 

  
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Diane I. Hines, DDS, PC
17701 W. McNichols Road | Detroit, MI 48235 | 313-533-6500
21500 W. 11 Mile Road | Southfield, MI 48076 | 248-358-4000
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