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Referrals

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  • 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:

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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 - 5:30pm
Tuesday
8:30am - 5:30pm
Wednesday
9:00am - 7:00pm
Thursday
8:30am - 5:30pm
Friday
8:00am - 4:00pm

Southbank Dentistry & Implant Clinic
Riverside Building,
Westminster Bridge Rd London, SE1 7PB
Tel: 020 7183 3558

Site updated September 2021 - Complaints Handling Policy - Privacy Policy - CQC - GDC
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