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Dental Referral

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Bromsgrove Dentals Patient Referal Program

At Bromsgrove Dental Clinic we offer a wide range of treatments and you can easily refer a patient to us if you are unable to perform these treatments for whatever reason.

We offer referral treatments for Dental Implants, Oral Surgery, Extraction, Orthodontics, Periodontics and Endodontics as well as treatment for Nervous Patients such as Sedation.

We believe in working with you, the referring Dentist and having a great working relationship to ensure the best possible outcome for your patient.

By you referring your patient to us, we can compliment your existing services yet still benefit the patient to ensure we both provide them with the highest standard of care.

Please complete our 'Refer a Patient' form below and once completed, our friendly reception team or a Dentist will be in contact with you to arrange a consultation date and time that is convenient.

To assist us, please provide as much information as you can and provide any relevant history and X-rays if available.

We will work with you and your patient to develop a treatment plan and discuss this and costs at the consultation where relevant.

Once treatment is approved and delivered, your patient will return to your practice so that you may continue to provide your patient with care.

We will provide you with a written report of the treatment and observations plus any further treatments / checkup's required.

If you have any queries about the form below or about referring a patient too us, please don’t hesitate to get in touch.

Dental Referal Bromsgrove Dental Clinic Worcester

Patient Referal Form


Patient Details

Date of Birth

Home Address


Referring Dentist Details

Dental Surgery Address


Referring Treatment Details

Please help us to understands the patients needs, kindly provide as much detail as possible.

Referring Treatment Details

Surgical extraction of retained rootsSurgical Extraction of Wisdom toothSurgical Extraction of other toothSurgical Crown LengtheningApicectomyAlveolarplastyOther - Please indicate below


Uploads

In this section, kindly upload any relevant Rediographs or associated files / images for review.



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