DENTIST REFERRAL
This form is for the use of dentists to refer their patients to us for orthodontic treatment.
PATIENT REFERRAL FORM
1. PATIENT DETAILS
Reason for referral
2. REFERRER DETAILS
Please send me more business cards
3. ATTACHMENTS
Upload any relevant photos and x-rays
Please wait to see thank you message after submitting.
Thank you, your referral has been sent to us. You will receive a copy of this referral by email.
SERVICES OFFERED TO REFERRING DENTISTS
PANORAMIC X-RAY (OPT)
Referrals for OPT x-rays can be carried out privately for a fee to the patient of £50. Simply send us a referral form with a detailed justification (online or paper).
CASE DISCUSSIONS/INFORMAL OPINION
If you have any queries about referring your patient for a consultation, we would be happy to discuss it with you. Some dentists regularly email radiographs or photos (with the patient’s consent) for a quick opinion. Remote consultations can offer an opportunity to discuss tricky cases.