Share Our Dental Practice with a Friend

State dental laws forbid us to reward you for recommending a new patient* to our practice, however, we can honor your friend for choosing us.

So, when your friend comes in for their first appointment, we will immediately write a $40 check to the Red Cross in their honor.

Plus, they’ll get their very own Punch Card (see below) so they and their family, and the Red Cross, can continue to be rewarded just for keeping their smile healthy and attractive.

Simply fill in this form and we will send them an email saying, “This friend has recommended our dental practice to you.”

If you write them a short note, we’ll include that as well.

Again, thank you for sharing us with others about whom you care deeply.

Your Full Name *

Your Email *

Your Friend’s Name *

Your Friend’s Email *

Write a Note to Them:

Information with an * is Required

* A new patient will have a new patient exam and x-rays.

Contact Us Today

  • Ken S. LeBlanc, DDS, PC
  • General Dentist
  • 202 Rue Louis XIV
  • Lafayette, LA 70508
  • Phone: (337) 406-9994
  • Email the Doctor

Patient Survey

BBB Accredited

New Patients
Refer A Friend
Smile Gallery
Free Report
Click the Book
E-Newsletter
Dr. Ken's Blog