For dental professionals

Refer a patient

We welcome referrals from colleagues across East London. Your patient stays yours — we treat, report back, and return them to your care.

Referral form

Send us the details

Referring dentist

Your name

Practice name

Practice email

Practice number

Practice address

Patient details

Patient name

Date of birth

Contact number

Email address

Address

Referral

Referral type

Reason for referral

Relevant medical history

Relevant dental history

Recent radiographs

Optional. JPG, PNG or PDF, up to 8 MB. Attached to the email and never stored on this website.

Anything else we should know

Referrals are emailed straight to the practice and are not stored on this website. Email is not end-to-end encrypted — for anything unusually sensitive, call us on 020 8821 2830 and we'll arrange a secure route instead.