Dentist Referral

Referral Form

    Patient Details

    Best time to contact *

    Referrers Details

    Relevant Medical History

    DiabetesCardiovascular diseaseGastro-intestinal disordersBone/Joint diseaseBlood disordersAllergiesRespiratory disordersLiver diseaseKidney diseaseCancerPregnant

    Further Information

    Reason for referral:

    Further Information

    Your patient will be contacted via telephone or post at the earliest opportunity. A consultation costs £145 for a 60-minute appointment and includes any further investigations including radiographs, impressions and study models. A detailed report outlining the current diagnoses, prognoses and suggested treatment actions will be sent within 5 working days of the consultation.

    To book an appointment or to know more about our services, please call
    01582 712 470 or email us at practicemanager@waysidedental.co.uk

    Get in Touch

    Contact us with your questions or to request a ring back. We'd love to hear from you.

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