Private Orthodontic Referrals

Referring Dentists Details

Patient Details

Referral Options

Select Referral Treatment*ImplantSedationEndondonticsCBCT

Additional Patient Details

Please indicate any relevant medical information and reason for referral. Please provide as much detail as possible to allow us to provide your patient with the best care possible.

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Our policy is always to ensure patients are returned back to their referring dentists for continuation of treatment and their routine care. If you wish Loughborough Road Dental Practice to provide ongoing dental care to your patient, please confirm below.

No, I wish the patient to be returned to my care once treatment is completedYes, I would like Loughborough Road Dental Practice to provide the ongoing care

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