MAKE A REFERRAL
PATIENT REFERRAL FORM
1. PATIENT DETAILS
Reason for referral
2. REFERRER DETAILS
Please send me more business cards
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.
Ritu Gupta and Stephanie Bryan, Orthodontists
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.