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Orthodontics Referral Form

Please fill in the form below for your patient's orthodontics needs.


Referring Dentist Details


Patient Details

 
 

Referral Requirements

 
 
 
 
 
 
 
 

What is Patient’s main concern for the orthodontic treatment?


 
 

 
 
 

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I was absolutely terrified of dentists in general before visiting the Alpha House Dental Practice - I would physically shake with fear. Unfortunately I developed a painful abscess and looked for a local dental surgery to me. All I can say is that I feel so lucky to be a patient of the Alpha House Dental Surgery. Mr Hussain is a wonderful dentist - caring, gentle and understanding.

He understood my fears and did his best to put me at ease. The whole team at Alpha House are excellent, second to none, and all are extremely caring and kind. For anyone with a fear of dentists please go and visit Alpha House to see Mr Hussain and his lovely team. It doesn't feel like any dental surgery I have ever visited before. You really will be in the safest hands. Thank you to you all!
We were most impressed by the way in which you and your team handled every aspect of the job down to keeping our 2 year old son entertained it made the whole thing a pleasurable experience.

MH

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