Referral

Refer a patient

Chapel Dental Care are pleased to offer a referral service should the need arise. We understand that it is not always easy to hand your patient to another dentist and feel 100% confident, However we promise that we will take the best possible care of your patient as we do with our own before returning them to your care. All referred patients will always be discharged back to your care. We do not have the facilities nor manpower to provide general dentistry on a continuing basis.




    Home address






    Referring colleague details and contact details

    Name of referring clinican


    Profession of referring clinican
    Dental surgeonDental hygienist / therapistGeneral medical practitioner







    Reasons for referral

    Emergency visits - does your patient require urgent attention for any of the following?

    ImplantsSix Month SmilesInman alignerWhiteningEndodontist

    Please let us know what you would like us to see your patient for?

    GDPR and consent

    Please read carefully and indicate consent where appropriate.

    It is normally more convenient during long treatments to co-ordinate hygienist appointments in-house. However, at the end of treatment, we will refer the patient back to your hygienist with notes on recommended home care unless you would prefer for us to look after the patient's future hygiene. It is normally a condition of our 5 year guarantee that the patient sees the hygienist at prescribed intervals during the year.

    All patients will be returned to your care at the end of treatment with a closing letter and we will actively decline to provide all non-essential treatment outside the remit of your referral without consulting you first.

    With your permission we would like to recall the patient at yearly intervals for a review and follow up and audit of our work.

    Consent for your referred patient's care at Chapel Dental - please tick as required:

    I consent to Chapel Dental contacting the above patient for the purpose of consultation and treatment as detailed aboveI consent to Chapel Dental carrying out all appropriate treatment as agreed with my patientI consent to Chapel Dental carrying out hygiene during treatmentI would prefer to continue hygiene care on my patient after treatment has been completedI would prefer hygiene visits to continue at Chapel Dental after completion of treatmentI consent to Chapel Dental continuing to recall my patient for review appointments as advised after end of treatment

    opening hours

    Mon:
    9am to 1pm - 2pm to 5.30pm
    Tue:
    9am to 1pm - 2pm to 5.30pm
    Wed:
    9am to 1pm - 2pm to 5.30pm
    Thu:
    9am to 1pm - 2pm to 5.30pm
    Fri:
    9am to 1pm - 2pm to 5.30pm
    Sat-Sun:
    Closed