This is a referral for the following treatment:

Implant treatmentRemedial implant treatmentImplant placement (with restoration)Implant placement (refer back for restoration)Periodontal treatment



Referrer Details:






Patient Details:








Some points to share with your patient

• We do not undertake general dentistry - patients remain in your general care

• Patients need to attend an annual dental implant check-up with us

THANK YOU FOR YOUR REFERRAL

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Sending this form back in another way

Print / Post: To ‘Referrals Manager’ at your nearest location:

DentalCarePlus London
25 Manchester Square
Marylebone
London
W1U 3PY
T: 01628 481532

DentalCarePlus Buckinghamshire
Chilterns House
49-51 Dean Street
Marlow
Buckinghamshire
SL7 3AA
T: 01628 481 532

DentalCarePlus Bristol
Ground Floor, Wynchgate House
Woodlands, Off Woodlands Lane
Almondsbury, Bristol
South Gloucestershire
BS32 4JT
T: 0117 366 0908

DentalCarePlus Cornwall
Block A, Florence Road Business Park
Kelly Bray
Callington
Cornwall
PL17 8EX
T: 01579 389 623

DentalCarePlus Manchester
268 Finney Lane
Heald Green
Cheshire
SK8 3QD
T: 0161 437 9622

DentalCarePlus Devon
Transit Way
Crownhill Road
Plymouth
Devon
PL5 3TW
T: 01752 782 050

DentalCarePlus Midlands
Lombard Lodge
Anchor Drive, Worcester Road
Stourport-On-Severn

DY13 9BZ
T: 01229 822 272

DentalCarePlus Wrexham
K1 Technology Park
Ellice Way
Wrexham
LL13 7YT
T: 01614379622.