Please find below referral forms for Orthodontics, Periodontology, Oral Surgery/Implants and 3 D X-rays. All of our forms can be downloaded and emailed to our NHS net account (firstname.lastname@example.org), please email us from your NHS net account.
Orthodontic Referral form
If you are a dentist and would like to refer a patient for NHS/Private Orthodontics, please complete and return the Orthodontic Referral form.
If you are a dentist and would like to refer a patient for private Oral Surgery/Implants, please complete and return the Oral Surgery and Implant Referral form.
If you would like to send a patient for NHS Minor Oral Surgery, please complete the NHS Warwickshire/NHS Leicestershire County and Rutland Minor Oral Surgery Referral forms. For Leicestershire these forms need to be sent direct to the PCT. For Warwickshire please post the forms direct to the practice.