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Referral of a patient by their GDP for an Implant Consultation

If you would like to refer your patient for a consultation for implant work with our specialist dentist, please complete the form below, attach any relevant radiographs, and a member of our team will be in contact with the patient directly. Thank you in advance.
1.Please provide us with the details below:(Required.)
2.Medical History - including all medications and any known allergies:(Required.)
3.Referring Clinician:
4.Referring Practice Name:
5.Clinical summary:
6.Do you want us to undertake the patient's routine dental care as well as any implant work, or are do you wish to undertake all routine dental care for this patient?