Name: Dentist Referrals - Dentist Bromsgrove - Private Dentist Worcestershire
Published: 2026-01-06T16:53:59+00:00

Our referral process

To refer your patient, simply fill in the online form below and we will be in touch. For more information, or if you would like to discuss your referral further, please contact us – we’re always happy to help.

We accept referrals for the following treatments:

Endodontics (£75.00 assessment fee)
Dental implants (£175.00 assessment fee)
Restorative treatment (£175.00 assessment fee)
Specialist orthodontics (Usually £55 fee, currently complimentary)
Oral surgery
Cosmetic treatment

Patient Details
Patient title:
Patient name:
Patient address:
Date of birth:
Patient email address:
Patient phone number:
Referring dentists details
Referring dentist:
Practice address:
Reason for Referral (please tick the relevant reasons)
Endodontics
Dental implants
Restorative treatment
Specialist orthodontics
Oral surgery
Cosmetic treatment
Other reason
If other please specify the reason:
Please provide a brief description about the affected tooth/teeth*:
Please provide 6 point periodontal probing depths around the tooth requiring treatment:
Radiograph Uploads
Please confirm a clear radiograph is attached (required)

Further Details (if required):
*By clicking ‘Submit referral' you are consenting to us replying, and storing your details. (see our privacy policy).

Dentist Referrals

Refer your patient for our high-quality dentistry

Our referral process

Patient Details

Referring dentists details

Reason for Referral (please tick the relevant reasons)

Radiograph Uploads

What do patients say about us?

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