Referrals

For our dental colleagues, it is our absolute commitment that all patients referred are returned to their dentist once they have been discharged from our care.

Please select how you would like to refer:

Online
By Email
By Post

REFER TO US BY ONLINE

This form below is for the convenience of dentists who wish to refer patients to one of our team members for specialist treatment

Please inform your patient that we ask for a deposit (except for free consultations) that is transferable with 48hrs notice for all of our appointments. The deposit is then deducted from the cost of the treatment.

ENTER YOUR REFERRAL DETAILS BELOW:

Patient Details:

I am referring the patient for:
Select at least one.

Periodontist Orthodontist Other

Other (Please Specify):

1. Patient Name

4. Patient’s Date of Birth

2. Patient’s Preferred Phone Number

5. Patient’s Email Address

3. Patient's Address

1. Your Name

2. Your Email Address

3. Your Phone Number

4. Practice Address

5. Detailed Reason for Referral/Case Description

6. Please upload relevant images/radiographs

7. Referral Date

REFER TO US BY EMAIL

Please kindly attach digital x-rays and photo’s that you feel appropriate along with either a covering letter or a completed scanned copy of our referral pro-former.

Click here to download the referral pro-forma

Please click here to email us on or use contact@broadwaydentalstudio.co.uk

Please click here to email the referral centre.

REFER TO US BY POST

Please complete referral pro-former (click here) and enclose any hard copies of radiographs/photographs you feel appropriate.

Our Address is:

Broadway Dental Studio Mill Hill
Flat 1, Broadway House (First Floor), 36–38 The Broadway,
Mill Hill, NW7 3LJ, London

Referrals

Please select how you would like to refer:

Online

By Email

By Post

REFER TO US BY ONLINE

Patient Details:

REFER TO US BY EMAIL

REFER TO US BY POST

Our Address is:

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