Referrals - Arndale Dental

Working in partnership with our referring dentists

Arndale Dental takes pride in our trusted partnerships with local dentists in our referral network, complementing your existing dental services and broadening the range of treatments for your patients. Our highly skilled clinicians have been seeing referred patients for many years. We are experienced at managing these relationships, so you can be assured that we will only treat your patients for the issue that has been referred to us.

To refer a patient, simply complete and submit the referral form below.

Make a referral

Patient details (step 1)

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First name *

Last name *

Address 1 *

Address 2 *

Postcode *

Date of birth *

Contact number *

Email *

Please check that the following fields have been filled out correctly:

Referring Dentist Details (step 2)

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First name *

Last name *

Phone number *

Practice name *

Practice address line 1 *

Practice address line 2

Practice city *

Practice county *

Practice postcode *

Email address *

Please check that the following fields have been filled out correctly:

Referral Details (step 3)

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Enter the name of the relevant clinician to refer your patient to (if known)

Observations & Dental History

General assessment of dental health

Oral hygiene *

Poor Fair Good Other

Teeth of poor prognosis *

Relevant medical history *

Additional files
- Please note that only the following file types are supported: jpeg, jpg, png, gif, pdf, doc, docx, xls, xlsx, rtf, ppt, odt.

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Confirmation

I confirm I have the requisite authority to share the patient's information in connection with this referral

Working in partnership with our referring dentists

Make a referral

Patient details (step 1)

Please check that the following fields have been filled out correctly:

Referring Dentist Details (step 2)

Please check that the following fields have been filled out correctly:

Referral Details (step 3)

General assessment of dental health

Please check that the following fields have been filled out correctly:

We are currently unable to process the form.