Refer a Patient

If you would like to refer a patient the options are:

By Phone: 0208 550 44 33 or 0208 551 7859

By email: [email protected]

By email: [email protected]

PDF referral form for periodontics View here

PDF referral form for endodontics View here

To save PDF: right click and select save Target as

Instructions: please can you down load the referral form and either email, fax or post with the relevant details and x-rays.

Do not email us patient's sensitive information such medical history, date of birth and address, the above should only be sent by post or fax (0208 551 7859- Please contact the practice by phone before faxing).

Use the online Referral form

Fields underlined are required:

Dentist's name :
Dentist’s address :
Dental speciality :	Implants           Prosthodontics Endodontics    Periodontics Hygienist
Dentist’s tel (work) :
Dentist mobile :
Reason for referral :
Patient's name :
Patient’s tel (work) :
Patient’s tel (home) :
Patient’s mobile :
Patient’s e-mail :
Enclosures :	x-rays     study models photos    other
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