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.

holywell.house@nhs.net

please email us from your NHS net account.

Endodontist Referral Form

If you are a dentist and would like to refer a patient for NHS/Private to the Endodontist, please complete and return the Endodontist Referral form.

endodontist treatment

Periodontal Referral Form

If you are a dentist and would like to refer a patient for private Periodontal Treatment, please complete and return the Periodontal Referral form.

Periodontal

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.

orthodontist

3D X-ray Referral Form

If you are a dentist and are interested in using our 3D X-ray machine then please complete and return the form.

x-rays

Minor Oral Surgery Form

If you are a dentist and would like to refer a patient for private Oral Surgery, please complete and return the Oral Surgery 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 Warwickshire please post the forms direct to the practice.

surgery