Dental Referral Service at Rock House Dental Practice

Rock House Dental Practice Patient Referral Service

We offer a wide range of treatments for which you can refer your patients on to us. Many local practices use our dental referral service and facilities.

We provide a dental referral service in the following areas:

- Oral Surgery, Wisdom Teeth Extraction, Tooth Exposure etc...

- Dental Implantology and Bone Grafting

- Dental Conscious Intravenous Sedation

- Orthodontics (Fixed, Removable & Aligners)

- Periodontics and Gingival Surgery

- Orthograde and Surgical Retrograde Endodontics

Working in partnership

We believe in  great working relationships. We will always work in close partnership with you, the referrer. We can complement your existing services and broaden the range of treatment options available for the benefit of your patients.

Rest assured, we only treat patients for the issue they have been referred to us for. If further treatment is needed, this will not be discussed with the patient or undertaken until we have spoken to you about this. Once our treatment is completed, we will discharge the patient back to your care.

How to refer

There are many ways you can refer a patient to us.

You can fill out the online referral form below, or download the PDF referral forms at the bottom of this page and  email them to us at info@rockdental.co.uk

Alternatively, please contact the practice, and we can send you a printed referral pack. You can then manually post referrals to us.

For the NICE Guidelines on referrals click here

 

Rock House Dental Practice Referral Form

Patients Title:
  • - select the patients title -
  • Mr.
  • Miss.
  • Mrs.
  • Dr.
  • Prof.
  • Other
Field is required!
Field is required!
Patients First Name:
Field is required!
Field is required!
Patients Last Name:
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Field is required!
Patients Date of Birth
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Patients Gender:
  • - select a option -
  • Male
  • Female
  • Mixed Gender
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Field is required!
Patients Ethnic Group:
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Patients Address:
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Patients City:
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Patients Post Code:
Enter a valid postcode
Enter a valid postcode
Patients Email Address:
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Patients Mobile Phone Number:
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Field is required!
Patients Phone Number:
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Patients Medical History:
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Field is required!

Referral Details

Please provide details of the referral below.
Dental Speciality
Please enter the area of dentistry you are referring for:
  • - select a option -
  • Endodontics
  • Orthodontics
  • Invisalign
  • Oral Surgery
  • Implantology
  • Dental Sedation
  • Periodontology
  • Hygiene
  • Cosmetic Dentistry
  • Restorative Dentistry
  • Prosthetics
  • Facial Aesthetics
  • Unsure
Field is required!
Field is required!
Please tick which practitioner you are referring to
Field is required!
Field is required!
Please tick which practitioner you are referring to
Field is required!
Field is required!
Please tick which practitioner you are referring to
Field is required!
Field is required!
Please tick which practitioner you are referring to
Field is required!
Field is required!
Please tick which practitioner you are referring to
Field is required!
Field is required!
Please tick which practitioner you are referring to
Field is required!
Field is required!
Please tick which practitioner you are referring to
Field is required!
Field is required!
Please tick which practitioner you are referring to
Field is required!
Field is required!
Please tick which practitioner you are referring to
Field is required!
Field is required!
Please tick which practitioner you are referring to
Field is required!
Field is required!
Please tick which practitioner you are referring to
Field is required!
Field is required!
Please tick which practitioner you are referring to
Field is required!
Field is required!
Please tick which practitioner you are referring to
Field is required!
Field is required!
Details Of Referral
Please provide details of the case and the treatment you would like us to provide
Field is required!
Field is required!

File Uploads

Do you have any xrays or documents you wish to upload and send with your referral?
Field is required!
Field is required!
Please upload your files here
Please upload your files here
Upload your documents...
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Field is required!

Referring Practitioners Details

Please enter your details below:
Your Title:
  • - select the your title -
  • Mr.
  • Miss.
  • Mrs.
  • Dr.
  • Prof.
  • Other
Field is required!
Field is required!
Your First Name:
Field is required!
Field is required!
Your Last Name:
Field is required!
Field is required!
Practice Name:
Field is required!
Field is required!
Address:
Field is required!
Field is required!
City:
Field is required!
Field is required!
Post Code:
Enter a valid postcode
Enter a valid postcode
Email Address:
Field is required!
Field is required!
Mobile Phone Number:
Field is required!
Field is required!
Practice Phone Number:
Field is required!
Field is required!
Submit

PDF Referral Form Download

Orthodontics Referral Form

Endodontics Referral Form

Oral Surgery Referral Form

Sedation Referral Form

Prosthodontics Referral Form

Implantology Referral Form

Periodontal Referral Form

Denture Technician Referral Form

Facial Aesthetics Referral Form

Hygienist Referral Form