Referrals

* are required fields

  • Patient Name

  • Patient Details

  • Referring Dentist's Details

  • Referral Details

  • Treatment Required
    Prosthodontics
    Periodontics
    Oral Surgery
    Endodontics
    Dental Implants
    Dental / Facial Aesthetics
    Orthodontics
    Other
  • Referral For
  • Advice   Treatment by specialist   Treatment with specialist jointly
  • Reason For Referral*
  • Relevant Dental History
  • Relevant Medical History
  • File attachment
    Please include any relevant file attachment such as radiographs, clinical notes or photographs. We accept the following files: JPG, PNG, DOC, DOCX, PDF
  • Any Comments:
  • I’d like to be informed of exclusive offers and other practice information YES

    *By clicking ‘submit’ you are consenting to us replying, and storing your details. (see our privacy policy).

Find Us

We are located on the first floor of County Hall. When visiting, walk to Westminster Bridge Road and take the arched entrance into County Hall.


Monday
8:30am - 6:00pm
Tuesday
8:00am - 5:30pm
Wednesday
8:30am - 5:30pm
Thursday
8:30am - 7:00pm
Friday
8:30am - 4:00pm

Follow us Online

Southbank Dentistry & Implant Clinic Riverside Building,
Westminster Bridge Rd
London, SE1 7PB

Tel: 020 7183 3558