Referral Guarantee
A clinician accepting a patient on referral will only undertake treatment they feel to be appropriate and that which lies within their competency. If the accepting clinician feels that alternative or additional treatment is required, this will be discussed with both the referring clinician and the patient and consent obtained for an amended treatment plan and any costs involved. Unless otherwise agreed with the referring clinician the accepting clinician will only carry out treatment in the capacity for which the patient has been referred to him/her.

Has this patient been referred to before
YesNo

Please arrange an appointment for:
ExtractionAlveoplastyApicectomyFrenectomyExposureDermal FillerBone GraftingSinus LiftingDerma FillersImplantsPre-Prosthetic Surgery

Anaesthetic:
Local AnaestheticIV Sedation