Professional Referals | Dental Specialists MK

GENERAL REFERRAL INFORMATION FOR DENTISTS

You can refer patients using our online form by fax, by mail or even by telephone and referral-letter packs are available from the practice.

Any radiographs that you can provide will minimize patient's costs. All treatment charges will be thoroughly discussed with the patient and a written estimate given, so there is no chance of any misunderstanding.

Patients are always advised to attend recall appointments with you and, except during active therapy, they are reminded to continue seeing your hygienist.

See below for referral options. Should you have any questions, do not hesitate to contact us at (01908) 630-169.

Referral Form

Dentist Referral Form - Download

Hygienist Referral Form

Hygienist Referral Form - Download

Online form Dentists

Dentists Online Referral Form

Fill in the online referral form below. Any radiographs you can provide will minimize patient costs.

Referral:

Your Email: *

Dentists Name: *

Contract Number: *

Surgery Address: *

Patient's Details: *

Patient's Telephone Number: *

Reason for referral: *

Are you aware of any previous referral/treatment?:

If Yes please give details: *

Relevant Medical History: *

Relevant Dental History: *

Information to follow: