Dr. Jeffrey E. Gust, Orthodontist 1000 E. 30th Ave. | Hutchinson, KS 67502 | TEL: 620-662-3255 2340 Washington | Great Bend, KS 67530 | TEL: 620-792-4217 129 E. 7th St. | Newton, KS 67114 | TEL: 316-283-1090 1325 E. 1st | McPherson, KS 67460 | TEL: 620-245-0411   If you are a doctor who is referring a patient to us, please fill out and submit the following form. Today's Date: Your Name: Your Practice Name: Your Email Address: Full Name of the Patient You Are Referring: Radiographs Sent? Yes No If yes, when were they sent? Comments Verification Code (case sensitive):

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