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Dentist Referrals

Dear Colleague,

We value you placing your trust in us looking after your patients. We will ensure your patients are treated with the utmost care and that communication is clear and timely. We will safely discharge the patient once the treatment has completed back to your excellent care.

If you would like our in-house endodontist Nihad Vaid for root canal therapy then kindly complete the referral form below. Our team will then be in touch within 24 hours of receipt.

    Referring for:


    Your Name*

    Practice Email Address

    Contact Number (optional)

    Patient Details:

    Patient Name*

    Patient Date of Birth (optional)

    Patient Contact Number*

    Patient Address (optional)

    Patient Medical History*

    Clinical Information*

    Please upload in .jpeg or .png format

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