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Welcome
to the Referral Portal

If you are an existing referrer and have been set up to use our referral system, please use the details provided to access the referral portal.

If you are a new referrer please use the online form below and if you would like us to set your portal details up please tick the box at the end of the form.

New Referrers

We accept referrals for specialist orthodontic & dento-facial orthopaedic / facial surgery treatment from:

  • General Dentists (GDPs)

  • Specialist Dentists

  • General Medical Practitioners (GMPs)

  • Specialist Medical Doctors

  • Allied Health Professionals

We accept referrals for dento-facial imaging from:

  • General Dentists (GDPs)

  • Specialist Dentists

  • General Medical Practitioners (GMPs)

  • Specialist Medical Doctors

Alternatively you can download a referral form below to send to us.

If you have any questions, please contact us at the clinic by email or phone. 

+44 (0)1483 971698 

Referrer Details

Patient Details

Upload Radiograph
Upload supported file (Max 15MB)
Upload Document
Upload supported file (Max 15MB)

REFERRAL SUCCESSFUL

WE WILL CONTACT THE PATIENT DIRECTLY TO MAKE AN APPOINTMENT

Download Referral Forms & Further Info

Orthodontic referral form
Cone Beam CT request form
Cone Beam CT information

Marble Surface
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