The hardest input UI in the app. All three mobile steps shown side by side, plus a desktop view of step 1 to show the tooth chart at full scale. Selection state is live — tap a tooth, change the segmented controls, check practices in step 3.
Step 1 · Procedure (with tooth chart)
9:415G · 87%
New referral
Step 1 of 3
Procedure
Specialty ·
Endodontics
Oral surgery
Procedure ·
Pick a common procedure or type your own.
Tooth
Patient's rightPatient's left
Maxillary · upper
Mandibular · lower
Selected2
#19, #30
Lower left first molar + lower right first molar
Pain level
Patient language
No matches.
Specialists who speak this language are ranked higher.
Step 2 · Patient context
9:425G · 87%
New referral
Step 2 of 3
Patient context
No patient identifying info. Don't enter names, phone, DOB, address, or insurance numbers anywhere on this screen. Specialists only need clinical context.
Age ·
Gender
Anxiety level
Clinical notes
Notes are visible to all specialists who receive the broadcast. 240 / 500 characters.
Step 3 · Match & broadcast
9:425G · 87%
New referral
Step 3 of 3
Match · 11 specialists
2.3 mi · Tran
4.1 mi · Webb
1.8 mi · Shah
5.7 mi · Kowalski
04Selected11Within 5 miSort: distance
Tran Endodontics
2.3 mi·Same-day slots·Match 94
Desert Root Care
1.8 mi·3 of last 5 booked·Match 91
Phoenix Endo Specialists
4.1 mi·Avg 3:12 reply·Match 87
Camelback Endo
5.7 mi·Spanish·Match 82
North Valley Endodontics
7.2 mi·New to network·Match 74
Ahwatukee Root & Pulp
8.6 mi·Avg 6:00 reply·Match 68
+ 5 more outside 10 mi
Web desktop · new referral · step 1 · tooth chart at full scale
app.referix.com/referrals/new/procedure
Referrals · New
Create a new referral
1Procedure2Patient context3Match · broadcast
Specialty ·
Endodontics
Oral surgery
Procedure ·
Pick a common procedure or type your own.
Pain level
Patient language
No matches.
Tooth
Patient's right (Q1 / Q4)Patient's left (Q2 / Q3)
Maxillary · upper
Mandibular · lower
Selected teeth2
#19, #30
Lower left first molar + lower right first molar
All fields valid
From step 1
Specialty
Endodontics
Procedure
— not set
Teeth
#19, #30
Pain level
Moderate
Language
English
Age ·
Gender
Anxiety level
No patient identifying info. Don't enter names, phone, DOB, address, or insurance numbers anywhere on this screen. Specialists only need clinical context.
Clinical notes
Notes are visible to all specialists who receive the broadcast. 240 / 500 characters.
Required: age
2.3 mi · Tran Endodontics
4.1 mi · Webb
1.8 mi · Desert Root
4.1 mi · Phoenix Endo
5.7 mi · Camelback
7.2 mi · North Valley
8.6 mi · Ahwatukee
04Selected
11Matched
3.5 miAvg distance
07:00Broadcast window
Practice
Distance
Signal
Match
Tran Endodontics
Dr. Linh Tran
2.3 mi
Same-day slots
94
Desert Root Care
Dr. Priya Shah
1.8 mi
3 of last 5 booked
91
Phoenix Endo Specialists
Dr. Marcus Webb
4.1 mi
Avg 3:12 reply
87
Camelback Endo
Dr. James Kowalski
5.7 mi
Spanish
82
North Valley Endodontics
Dr. Sara Bennett
7.2 mi
New to network
74
Ahwatukee Root & Pulp
Dr. Robert Chen
8.6 mi
Avg 6:00 reply
68
+ 5 more outside 10 mi
Request window: 7 minutes · responses arrive in real time