Referrals

• We accept referrals in:

  Our highly skilled clinicians have been seeing referred patients for many years. We are experienced at managing these relationships, so you can be assured that we will only treat your patients for the issue that has been referred to us.

  • Prosthodontics
  • Dental implants
  • Aesthetic dentistry
  • Periodontics
  • Endodontics

• Refer a patient

  To refer a patient, simply complete and submit a referral form.

  After reviewing, we will contact the patient to introduce ourselves and book them in. You will be kept fully updated on progress throughout.

   

   

   

   

Make a referral

Patient details (step 1)

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First name *

Last name *

Address 1 *

Address 2 *

Postcode *

Date of birth *

Contact number *

Email *

Please check that the following fields have been filled out correctly:

Next stage

Referring Dentist Details (step 2)

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First name *

Last name *

Phone number *

Practice name *

Practice address line 1 *

Practice address line 2

Practice city *

Practice county *

Practice postcode *

Email address *

Please check that the following fields have been filled out correctly:

Next stage

Referral Details (step 3)

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Enter the name of the relevant clinician to refer your patient to (if known)

Treatment required *

Please select... Invisalign Same day teeth Oral surgery Implant secured dentures Multiple dental implants Single dental implant Dental implants Dental veneers Teeth whitening Smile styling Dentures Dental bridges Dental crowns Replacing teeth Root canal treatment Fillings Repairing teeth Hygienist services Dental check ups Emergency appointments General dentistry

Observations & Dental History

General assessment of dental health

Oral hygiene *

Poor Fair Good Other

Teeth of poor prognosis *

Relevant medical history *

Additional files
- Please note that only the following file types are supported: jpeg, jpg, png, gif, pdf, doc, docx, xls, xlsx, rtf, ppt, odt.

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Any comments

Confirmation

 I confirm I have the patient's consent to share this information

Please check that the following fields have been filled out correctly:

Finish

Submit

Get in touch to learn more about referrals

Contact us