Referral Service & Protocols

Services for Referring Dentists

Our aim is to provide a premier referral service. Please fill the form below or download the form by clicking HERE

Referrals are accepted for implant placement, implant restoration and all types of bone and soft tissue augmentation in relation to implants. Implant work can be completed in it’s entirety, or referred to us for treatment planning and the surgical phase of treatment only, with the restorative element being completed by the referring practitioner.

All treatment is carried out on a strict referral protocol, all patients will be returned to their routine dentist for ongoing care once treatment has been completed.

Patient Information

NAME
DATE OF BIRTH
ADDRESS
PHONE
EMAIL
HOW SHOULD WE CONTACT PATIENT
RELEVANT MEDICAL HISTORY

Dentist/Surgery Information

NAME
PRACTICE
ADDRESS
PHONE
EMAIL
PREFERRED METHOD OF CONTACT

Please Indicate Requested Treatment

IMPLANTS

Implant placement onlyImplant placement and restorationBone graftingSinus augmentation

CBCT/OPG Xrays

Digital PanoramicCBCT

Sedation

yesno

PLEASE PROVIDE DETAILS OF REQUIRED SCAN/XRAY, PREGNANCY, ANY MEDICAL CONDITION, RESON FOR THE SCAN*