top of page

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

We want to make private healthcare as affordable and accessible as possible.

Membership Plans Available

Book an appointment with us online, or on the phone.

Book An Appointment
bottom of page