Refer a Patient – Dorchester

Please use the form below to make a referral.

You can also get involved with restoring implant cases:

Refer a patient to us for a consultation with one of our dentists and make sure to let us know that you want to be involved in the restoration part of the treatment. You can do this by post, email or online. We will contact your patient to invite them for a consultation and let you know what they decide. If they wish to proceed we will arrange surgery for a day when you are available to come in and work with us. For more information why not attend one of our relax events in either our Merley or Dorchester practice? Keep an eye on our list of courses for when the next event is!

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

Services Required (please give details, i.e. Opinion only, Comprehensive dental care):
Implant Requirement (please give details, i.e. Single tooth missing, Multiple teeth missing):
Affected Areas (please give details, i.e. upper, lower, both):
Brief History (about this referral):

Additional Information

Patients knowledge of treatment required:

Patient aware of level of investment required

Would you like to attend the patients visit

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.

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The Most Prestigious Referral Practice In The South West

Refer a Patient – Dorchester

Please use the form below to make a referral.

Practice Details

Patient Details

Referral Details

Additional Information

Radiographs & Clinical Photographs

Info For Dentists

Patient Testimonials

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