Test form


REFER 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.
REFER 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.

Send email to [email protected]

REFER BY POST

Please complete referral pro-former (referral-form) and enclose any hard copies of radiographs you feel appropriate. Our address is:

Mouth Dental
1 – 2 Raleigh House
Admirals Way
London
E14 9SN

Nine Elms, Battersea
2 Ravine Way
Legacy 1 Building
Embassy Gardens, Nine Elms
Battersea, London
SW11 7AY
[email protected]
South Quay, Canary Wharf
1 – 2 Raleigh House
Admirals Way
London
E14 9SN
020 7987 1212
[email protected]
Churchill Place, Canary Wharf
Unit 11, 2 Churchill Place
Canary Wharf
London
E14 5RB
020 3384 1212
[email protected]