Please complete this secure form below, starting with referring dentist details and then upload the patient referral letter and images in the ‘file upload’ section. Then submit the form.
Once the completed form has been submitted we will make arrangements to see your patient at our earliest possible convenience.
If you are having any trouble please contact any of the practices listed here or alternatively email firstname.lastname@example.org
Files are transferred to secure Microsoft Azure servers using 256 bit SSL encryption. This is the same technology used by e-commerce services and online banking. Files are stored with 128-bit RC4 encryption.