Referral Form

Referral for:

- Sedation

- Oral Surgery

- Implant dentistry

- Root canal Treatment

- Implant Maintenance Hygiene

- Restorative work with Sedation 

- Facial Cosmetics (botox and dermal fillers).


Please complete the online form and submit. Alternatively please print out the PDF and post the completed form to 58 Billet Lane, Hornchurch, Essex, RM11 1XA or scan the completed form and email to

Download the Referral Form

Patient referral PDF

Referral cover letter PDF

Membership Plans Available
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Contact Us

58 Billet Lane Hornchurch

Essex, RM11 1XA

Opening Hours

Monday & Wednesday:  09:00AM – 17:00PM

Tuesday & Thursday:  09:00AM – 18:00PM

Friday:  09:00AM – 14:00PM

Saturday: Hair Clinic Only

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