Referral Form for Dentists

ROOT CANAL TREATMENTS

Root Canal treatment referral fees are shown below.

Consultation £85
Root canal treatment Incisor/Canine £750
Pre Molar £850
Molar £950
Removal of existing root canal filling £100

Any other treatment is quoted during consultation. The root canal specialist is Jelena Kosoric.

ORAL SURGERY, IMPLANTS & ORTHODONTICS

Oral Surgery Referrals are carried out by Fahad Jamil and Orthodontic Referrals are carried out by Shima Sharara and prices are the same as shown on the fees page.

DENTIST REFERRAL FORM

Referral Type

Endodontist

Oral Surgeon

Orthodontist

Free Text

REFERRING DENTIST DETAILS

Dentist First Name:

Dentist Last Name:

Dentist Email:

Dentist Phone Number:

Dentist Practice Address:

Free Text

PATIENT INFORMATION

Patient First Name:

Patient Last Name:

Patient Date of Birth

Urgent Case?

Yes

Patient Email:

Patient Phone Number:

Patient Address:

Service Required:

Treatment

Opinon Only

Other

Case Notes for Referral:

Upload Notes or X-Rays

Click here to upload a zip file for notes and x-rays

Opt In

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Referral Form for Dentists

ROOT CANAL TREATMENTS

ORAL SURGERY, IMPLANTS & ORTHODONTICS

DENTIST REFERRAL FORM

ADDRESS