dovetail cosmetic dentistry newcastle

Call Today To Book Your Free Assessment: 01912837166

Patient Referral

We offer a free initial consultation for your patients. Generally this is sufficient for us to discuss treatment options in broad terms and give approximate costings where possible. If you can provide relevant radiographs then this enables a more detailed discussion.

If your patient requests we will move to a comprehensive analysis from which we will present treatment options.

Thank you for your kind referral.

Referring Dentist (required)

Practice address

Contact number(s)

Email

Patient name (required)

Home address

Contact number(s)

Email

Date of birth

Do you want us to provide options for treatment that is:

Full Mouth

Full arch - Upper

Full arch - Lower

Localised - Teeth/gaps

Is treatment urgent?

Is the patient particularly anxious?

Summary of problem

Relevant dental history

Relevant medical history

Are you providing any other treatment for the patient?

When would you like us to contact you?

Before we meet the patient? After consultation and diagnosis? After treatment completed? At regular stages throughout treatment? 


Your email (Enter if you require a copy of the referral for your records)

Attachments (e.g. X-rays)



Once again, thank you for your kind referral

Dovetail Bespoke Dental Solutions Located at Amy House, 61 Blandford Square Newcastle upon Tyne, Tyne and Wear NE1 4HZ
Copyright: Dovetail Bespoke Dental Solutions
01912 837 401