If you are a practitioner and you wish to refer a patient, please use the form below.
The initial consultation is 30-45 minutes long and the fee includes any radiographs taken. Patients at this stage will receive an indication if they are suitable for treatment, approximate costs and discussion of alternative treatment which can be provided by the referring practitioner.

The initial consultation charge is currently £80.

All Patients remain registered with the referring dentist.

Please choose one or more of the following services:
Implants
Oral Surgery
Bone Grafting
Cosmetic Treatment
Full Mouth Rehabilitation
IV Sedation
.................................................
Fill-in the following form and click on the "Submit" button to send your form.
Date:
Dentist Name: *
Dentist Email: *
Do you request a telephone call prior to patient's appointment?		yes no
Patient's Name: *
Patients Date of birth
Address:
Telephone Number: *
Reason for referral:
Your evaluation / assessment:
X-rays attached?		yes no
X-rays to be sent?		yes no
		Please enter code in box below
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