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?* YesNo

Patient's Name:*

Patient's Phone:*

Patient's Address:*

Appointment Details

NHS or private?*NHSPrivate

Purpose of appointment?*

Additional Details

Your comments:

Send a referral pad?*Yes pleaseNo thanks

Are you an existing Hampstead Practice referring dentist?*YesNo