COVID-19 UPDATE »

Dental Treatment Referral

For non-CT scan referrals please use the form below to submit your referral.

If you wish to refer a patient for a CT scan, please click here.

Patient Details

Reason for Referral (Please tick box)

Referring Practitioner Details

  • *By clicking ‘send’ you are consenting to us replying, and storing your details. (see our privacy policy).