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

Please check your spam/junk folder if you do not receive an email confirmation once you have submitted the form and add us to you safe senders list.

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.

Type of referral

Your Details

Your Patient's Details