Welcome and thank you for your kind referral and entrusting the care of your patient onto us. We aim to make your patients confident and happy returning for routine check-ups following comprehensive care.

Information from the Referrers

Any records will be immensely helpful to fully assess the patient's dental concerns. If you would like to email digital records to us, please do so at If you include any originals in your referral, we will be able to scan them onto our database and subsequently return them to you.

If you believe that the initial assessment conducted by us would be assisted by the examination of old and/or new OPGs, it would be highly appreciated if you could direct the patient to do so before coming to see us.

Please use the form below to begin the referral process, otherwise you can email us:



Date *
Patient Name *
Patient Name
Patient to be seen for *
Ongoing care required *
Radiographs Emailed *
Radiographs can be emailed to: