Referring Dentists


For successful orthodontic treatment, on-going communication between the general dentist and orthodontist is paramount. We remind patients of this close relationship and encourage them to visit their dentist at least every six months.
To refer a patient for an orthodontic assessment, please complete the online Referral form below. We will contact your patient and arrange a convenient appointment and keep you informed of the patient’s treatment plan and progress.

Practice Details


Practitioner's Name:*

Practice Phone:*

Practice email:*

Patient Details


New patient?*  Yes No

Patient's Name:*

Patient's Phone:*

Patient's Address:*

Appointment Details


NHS or private?* NHS Private

Purpose of appointment?*

Additional Details


Your comments:

Send a referral pad?* Yes please No thanks

Are you an existing Hampstead Practice referring dentist?* Yes No