Referrals

If you are a practitioner and would like to refer one of your patients to us for treatment, simply complete the form below. Once submitted you will receive a confirmation email for your records and one of our treatment coordinators will contact the patient to arrange an appointment. For more information about the services we offer to help clinicians with diagnosing and treatment planning or if you have any difficulties with this form, please contact us. If you would prefer to print a hard copy of the referral form please click here for an NHS orthodontic referral form or click here for a Private Referral Form.

 

 

Benefits of scale and polish

NHS ORTHODONTIC ASSESSMENT & REFERRALS

QUICK REFERENCE GUIDE View or Download Here
need-a-cbct-scan

NEED A CBCT SCAN?

To refer a patient for a CBCT scan please download the form below which will need to be printed and signed by the referring clinician. CBCT Referral Form



    Type of referral







    Your Details













































    Your Patient's Details


































    We take your privacy seriously and we will only use the details you provide to respond to your enquiry or in order to fulfil your request.
    AcceptDecline


    We will never sell your data or share it with any third parties


    From time to time we would like to contact you with information about the services we offer as well as CPD peer review events that may be of interest to you. Please indicate if you are happy for Resolution to contact you via email for this purpose.
    AcceptDecline


    If you wish to see what data we hold on you or wish to have your data deleted please email us on: mail@resolutionsmile.com