Periodontal Referral Form

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


Referring Dentist Details


Patient Details

 
 

Referral Requirements

 
 
 
 

 
 

 
 
 

Up to 9mb files only



 

By submitting this form you understand that your data is processed in accordance with our privacy policy.


Please input reCAPTCHA above

5-star-dentist-dental-surgery-birchington-kent.png

Before I came here I hadn't been to a dentist for nearly 30 years. It was only when my gums became sore and I kept having dreams that my teeth were about to fall out, that I finally decided I really needed to do something.

Mr Hussain completed a thorough examination, in which he took the time to really listen to me, without being at all judgemental. The treatment and recommendations that he made have completely changed how I feel about my teeth, and I am truly grateful to him and his team. If anyone is looking for a new dentist, where you are really treated as an individual, and will receive excellent care and treatment, I would certainly recommend this surgery.

Mrs B

CQC Care Quality Commission LogoDental Phobia Certified LogoPhilips Zoom Whitening Logo
Consent Preferences