DentalHouse have a number of dentist with specialist skills; we are happy to receive referrals for specialist dental treatment.

Please complete the form below with appropriate details.

This is intended for use by dental professionals only; members of the public please get in touch with the relevant practice directly, thank you.

    * Indicates required field

    Referring Dentist

    Patient Details


    Is this referral urgent?*

    Supporting document 1
    (4MB max, PDF, DOCX or JPG format only)
    Supporting document 2
    (4MB max, PDF, DOCX or JPG format only)

    Supporting document 3
    (4MB max, PDF, DOCX or JPG format only)
    Supporting document 4
    (4MB max, PDF, DOCX or JPG format only)