Dental TreatmentX-rayReferral CharterDENTAL REFERRAL TEAM

For cosmetic and restorative dentistry, dental implants and orthodontic referrals please complete the following form. Alternatively, you may download the referral form and send it by post or fax (020 7580 9343). Please call us to arrange an appointment for your patient on 0207 255 2559 or we can contact your patient directly if you prefer.


Referring Practitioner


Patient details


Reason for Referral *

Cosmetic dentalImplants onlyImplants and final restorationOrthodonticsPeriodonticsEndodontics

Case description

Investigate and treatFor opinion only
Class 1Class 2Class 3

Attachments (relevant photos or X-Rays)

30MB total maximum file size (.jpg and .jpeg)

We offer a referral service for both 2d and 3d radiography. Offering pre-bookable and a walk-in service for patients needing Cephs, Opgs and CT scans.

Please complete the following form. Alternatively, you may download the referral form, complete and give to your patient to bring with them.

1. Expertise

Our aim is to ensure that both the referred patient and you, the referring dentist, are delighted with the quality of our clinical expertise and the level of care and attention they receive from us.

2. Trust

We will only carry out the treatment previously agreed with the referring dentist. We will always refer patients back for any other treatments, unless you request otherwise.

3. Choice and consent

After the initial consultation, we will always provide the patient with a written treatment plan, a copy of which is always sent to the referring dentist. No treatment will be carried out without an estimate of fees given to the patient.

4. Care

In the rare event where complications arise after the patient has been treated by us, we will always ensure that they receive the remedial care they require immediately.

5. Support

Our aim is to ensure that as part of your extended dental team, we can add extra value to the overall patient experience you offer. We will support you and your patient every step of the way.