Types of referrals

We are happy to receive referrals from GPs, orthodontists and dentists but also welcome enquires directly from patients. Patients are referred from a wide variety of professional clinicians including general dentists, family doctors and dental specialists (for example orthodontists).

Referrals also come from other surgeons who recognise the specialised training required for the treatment of conditions involving the mouth, jaws and maxillofacial region.

Referral form

If you would like to make a referral, please complete the form below.

Dentist/GP Details

Dentist/GP Name (required)

Dentist/GP Address:


Patient Details

Patient Name:

Date of Birth:

Patient Address:

Home Phone:

Business Phone:

Mobile Phone:

Email Address (required)

Reason for Referral

Would you please examine the patient and: (Tick appropriate boxes)
 Assess and treat as needed Please phone me Treat as indicated Significant medical history