Updated August 2026 — Documentation Requirements

Submitting this referral initiates the CCC process. A case is not scheduled for interdisciplinary review or medical/surgical attestation until the required clinical documentation has been received and reviewed for completeness.

Please email to hello@cccofnwa.com: complete medical history · clinical examination findings · intraoral photographs (full-arch, occlusal, retracted) · extraoral photographs (frontal, profile) · current CT/CBCT within 12 months · phased treatment plan with scope, sequencing, and specific treatment sites · documentation of functional impairment related to the qualifying craniofacial diagnosis

Additional records may be requested depending on diagnosis and proposed treatment.

How we can help

The provider presents us with their treatment plan, and we review it to ensure it meets standard level of care.  

  • The patient’s treatment preference heavily influences our approval process 

  • We help review medical insurance coverage and fulfill any state mandated processes are met in order to leverage medical insurance.  

  • If the treatment plan provided by the provider requires an additional specialist, we collaborate with the provider to complete this plan. 

  • If there is a gap in the patient’s care team, ie a primary care provider or mental health professional, we provide patients with names and/or referrals to these providers to ensure they have knowledgeable providers as a part of their overall care.  

Doctor Referral Form

Thank you for choosing us to be a part of your patients care team. If you have records that you would like to share with us, please email them to hello@cccofnwa.com