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Implant Referrals

We welcome dental implant referrals as well as CBCT scan referrals from other practices. We adhere strictly to professional ethics. Patients referred to our practice would be treated only as per the referral request. For all other treatments (not mentioned on the referral form), patients have to consult their dentist.

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Patient's Details

Referring Dentist's Details

Treatment Details

Please tick relevant boxes
Is patient a smoker?
BPE Status

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