Please add as much relevent clinical history information as possible, If referral related to a CT scan please add justification for scan.
Please add ad much relevant medical history as possible, in particular significant conditions, allergies or medications.
Please tick the supporting material you will be posting us or attaching. If you have any relevent radiographs, please so send them preferably by email or by attaching to this referral. Enclosures can also be emailed to [email protected] under separate cover. If emailing or uploading attachments ( e.g. X-rays) , for security please omit patients name but add the following details in the subject line: Patients initials, Patients Date of Birth, Referring Dentists Name.