This form is intended for GDC registered dentists to refer patients to us only. If you are a
patient please go our Contact Us page to get in touch.
Please indicate referral treatment needs in the relevant sections below.
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.
(If you are attaching files it will take upto a minute to submit, once you have clicked
submit please wait for the page to refresh, You can upload maximum of 4 files)
Select Files (Maximum of 4 files)