Referrals

We accept referrals using the following online form for dental implants, peri-implantitis management, fixed and removable prosthodontics, cone beam CT scans and intra-oral digital scans.

Type of referral

Referrer name

First Name

Last Name

Referrer email

Referrer phone

Referrer address

Patient name

First Name

Last Name

Patient email

Patient phone

Patient mobile

Patient date of birth

Patient address

Reason for referral (if requesting a radiographic report with a CBCT scan please indicate this below)

Recent dental and medical history

Additional information

Referrals

Location

Hours

Contact