Referrals to The Dental Hub

Referrers Details

Referring Dentist Name

Referring Dental Practice Name

Referrers Email

Referrers Telephone Number

Referring Dentist GDC Number

Patient Name

Patient Telephone Number

Patient Date of Birth

Patient Email Address

Patient Address

Patient Medical History

Referral For:

Practice you are referring to

Treatment Required (Case Details)

Any Other Details

Upload relevant clinical images (Maximum file size 5MB)

Click or drag files to this area to upload. You can upload up to 5 files.

For CBCT or OGG the referring dentist must agree to the report statement below in order for us to accept the referral.

Report Statement for a CBCT or OPG

I the referring dentist, confirm that I am qualified to refer and agree to report on the radiograph taken

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Site last updated Jul 2025

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