New Patients Dental Referrals 01323 639802

Patient Referral Form

If you are a General Dental Practitioner, wishing to refer someone to Orchard Dental Practice please complete the form below, and we will be in touch shortly.

Your practice

The patient

The referral

Radiographs, photographs, OPG or CBCT exports — JPG, PNG, TIFF, PDF, DICOM or a ZIP. Up to 5 files, 25 MB each. A study off a PACS or a CD often has no file extension, so put it in a ZIP. If an attachment fails we still receive the referral, and we will ask you for it.

We'll use the details you give us to respond to your enquiry. See our Privacy Policy for how we look after your information.

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