Use the form below to refer your family & friends to AHC! There is no limit to the amount of referrals you can send!

(One form submission per referral.)

An email will automatically be generated and sent to them with a link to schedule a complimentary exam and x-rays, courtesy of you!

For every patient you refer, you will be entered into a drawing to win your choice of a $150 Amazon gift card or $250 AHC credit!

Your Full Name *

Your Phone Number

Your Email *

Enter your friend/family member's information below:

Referral's First Name *

Referral's Last Name *

Referral's Phone Number *

Referral's Email *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.