For referring clinicians

Refer a Patient

Use this referral route to request specialist advice, assessment or treatment. Relevant clinical information and radiographs will be provided through a secure service before launch.

We work within the agreed referral remitReferring clinicians are kept updatedPatients are returned to their referring dentist as appropriate

Secure referral form · ready for activation

Secure form temporarily locked

Checking the secure form compliance configuration. The form remains locked.

1 Referring Dentist
2 Patient Details
3 Referral Details
4 Clinical Files
Radiographs, photographs and reports

Attach the records needed to assess the referral. Do not include unrelated patient records.

JPEG, PNG, HEIC, WebP, PDF or DICOM · up to 10 files · 15 MB each
5 Consent and Submission
Submission is disabled while the compliance gate is locked.

Privacy Notice

Do not send confidential patient information by ordinary email. Clinical information and files must be submitted through the secure referral form once activated.

Email Dr Daoudi