Lafayette, LA - Barras Family Dentistry


	116 Rue Beauregard Lafayette, LA 70508 (337) 235-3395

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Refer a Friend

To refer a friend fill out the information below.
• An Email will be sent to the address you have provided.
• We will contact your friend if they respond saying that they would like more information about our office.
• Thank you for referring us to your friends.


	*Friend's first name:	*Friend's last name:
	Friend's phone number:
	*Friend's email address:
	*Your first name:	*Your last name:
	*Your email address:
	Notes:
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