Dental referrals

If you would like to refer a patient to see Ben or Claire, please either complete the form below and submit it online or you can print a copy off and send it in the post. Once we have received the Referral Form we will let you know that we have received it and then contact your patient direct to make an appointment with Ben or Claire. We will obviously keep you fully informed of your patient’s progress and it goes without saying that all information provided is treated in the strictest confidence. If you have any questions or concerns about referring a patient to Ben or Claire please do not hesitate to call us at the Practice.

If you prefer, you can download a printable version here: download

Referring practitioner details

Reason for referral

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Patient details

Additional information