R P Advanced Dental Centre

Referrals

Refer & Get Rewarded

Existing patients who introduce a friend or family member can also receive a complimentary hygiene session, subject to the applicable terms.

The Referral Process:

Once we receive a referral, our team will review the information provided and arrange an appropriate appointment for the referred patient.

When making a referral, please provide as much relevant information as possible. This can help our team understand the patient’s needs and may save the patient time. For more details, please see our Referral Policy.

Referral Form

Please fill out the form below with the patient’s details and your contact information. If you are a dentist or healthcare professional, please include any relevant information or supporting documents to help us assess the referral.

Patient Contact Details

Patient Name*

Patient Email Address*

Patient Telephone Number *

Patient Address

Referrer Details

Referror Name*

Referror Email*

Referror Telephone Number *

I am referring as

Brief description of request

required fields marked *

Our Referral Policy

We assess each referred patient according to their individual needs and the information provided with the referral.
For professional referrals, treatment will be carried out in accordance with the instructions and agreed scope of the referring clinician.
No additional treatment will be carried out without appropriate discussion and, where required, authorisation from the referring clinician.
The patient will receive a detailed treatment plan and all costs will be discussed before treatment begins.
We will keep referring healthcare professionals updated throughout treatment where appropriate.
We aim to provide a full treatment report to the referring clinician within two working days of completing the referred treatment.
We aim to return patients’ and referring professionals’ calls within 24 hours if they have any queries.
We use modern, evidence-based procedures, materials and equipment as appropriate to each patient’s needs.

Referring Dentist Contact Details

Dentist Name*

Dentist Email*

Dentist Practice Address

Practice Postcode

Practice Telephone Number *

Dentist Mobile Telephone Number

Patient Contact Details

Patient Name*

Patient DOB

Patient Address

Patient Postcode

Patient Telephone Number *

Patient Mobile Telephone Number

Patient Email Address*

Referral Details

Referral For:

Urgency:

Brief description of request

Comments

Attach radiograph file if available:
Please attach file as a jpeg, file size no greater than 3MB

OTHER COMMENTS