Patient Referral Form
Dear colleague, please use the form below to refer us Private PERIO, ENDO & IMPLANT cases. Please be clear and concise and please be reminded your patients will be charged a consultation fee as per fee guide. In cases where adequate information is provided by the referring GDP patients on payment of a suitable deposit may be booked in directly for treatment at the practices discretion and the consultation fee will be waived. Also, rest assured that on completion of any appropriate treatment your patients will be promptly returned to your continual care. Many thanks for your referral.
Any detailed information of patient or file attachments can be emailed to us at firstname.lastname@example.org