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 020 7255 2559 or we can contact your patient directly if you prefer.

Referring Practitioner

Practitioner Address(Required)

Patient Details

Patient Name(Required)
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Patient Address

Referral Details

Reasons for referral(Required)

Case Description

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Skeletal class(Required)
TMJ symptoms(Required)
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    Please note: All photographs submitted to us will be kept strictly confidential and not shared with any 3rd party.

    Referral charter

    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.

    How can we help you?

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