Referral

To refer a patient for endodontic treatments or consultation, please complete our online referral form or contact us directly at our phone 01224 076016 or email - ci.dental.nr-endo5556@nhs.scot
We are always happy to discuss cases prior to referral and provide advice on case selection or treatment planning

Patient's name

First Name

Last Name

Date of Birth

Patient's email

Patient's phone number

(###)

###

####

Patient's address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Referring dentist

First Name

Last Name

Dentist/dental practice email

Referring dental practice

Referral type

Referred for

Brief history of the tooth/teeth