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Private Patient Referral Form

At SC Dental Studio, we are able to accept patient referrals from other dentists and dental professionals. If you have a patient and you are unable to treat them, please do not hesitate to contact us by phone or fill out our online patient referral form, or if you would prefer to download our referral form to print, fill out and post to us.

PLEASE NOTE!
We can only accept private referrals online or by post. All NHS referrals must be directed through the Vantage Rego Patient Referral system, you can find the link here: https://ref.management/login

If you wish to refer a private patient, please fill in the online form below.

Downloads

Sedation Leaflet

Download Here

Online Patient  Referral Form

 

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PATIENT DETAILS

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Please enter your surname or last name
Please enter your first name
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Please enter the first line of your address
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Please enter your town or city
Please enter your county
Please enter your postal code.
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Next Of Kin Details
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TREATMENT REQUIRED

Please carry out the dental treatment detailed below anxiety management techniques/L.A. You decide what is the most appropriate to patient.






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REASON FOR REFERRAL

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REFERRING DENTIST

I understand that the decision as to whether the treatment will be provided using sedation will be taken by the treating Dentist and Anaesthetist. Minor Risks - This may include damage to teeth, stiff neck, headache, nausea & vomiting.
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Please ensure that the following are provided to avoid delay in the patient treatment. 1 Medical History 1 Radiographs (All recent radiographs must be enclosed) 1 Please prioritise your treatment plan. Sedation response varies with individuals and be aware that extensive treatment plans may not be completed on single visit sedation.

Opening Hours

  • MON - SAT:

    9am - 5pm

  • LUNCH:
    Closed

    1pm - 2pm

  • SUN:

    Closed

  • BANK HOLIDAYS:

    Closed

  • EMERGENCY :
    Please call

    01753 825 450

Treatments