How To Refer

Referral can be made by letter, email, via our website or phone. It is useful to inform the patient that the referral is on a private basis.

Any relevant radiographs are useful.

Your patient will be contacted by telephone and an appointment scheduled, they will be provided with directions and an estimate of cost.

Under no circumstances will any patient be accepted for general dental treatment following referral.

Click here to download our referral form or complete our online referral form below:

Practice Details

Referring Practice:
Referring Dentist:
Practice Email:
Practice Address:
Telephone (Work):
Telephone (Home):
Telephone (Mobile):

Patient Details

Patient Name:
Date of Birth:
Patient Email:
Patient Address:
Patient Telephone (Work):
Patient Telephone (Home):
Patient Telephone (Mobile):

Referral Details

Treatments Required (Consultation Only / Root Canal / Consultation & Root Canal):
Medical History (about this referral):

Practice For Referral

Please state practice for referral
(Poole/Dorchester):

Radiographs & Clinical Photographs

If you would like to attach any radiographs, clinical photographs or any documents that you feel would be of use, please use the upload facility below.

Upload 1:
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