Refer a Patient

Refer

Cases accepted

Endodontics

✓ Root canal treatment
✓ Root canal re-treatment
✓ Complex & multi-rooted
✓ MTA placement
✓ Ledge & broken file management
✓ Resorption & perforation
✓ Endodontic microsurgery

Restorative

✓ Tooth wear management
✓ Full mouth rehabilitation
✓ Dahl restorative cases
✓ Occlusal splint therapy
✓ Composite bonding
✓ Dental veneers
✓ Smile makeovers
✓ General restorative

Referral Form

Please complete all fields where possible.

Referring Dentist / Practice

Your Name *

Practice Name *

Email *

Phone

Practice Address

Patient Details

Patient Full Name *

Date of Birth *

Patient Phone Number *

Patient Email

Patient Address

Clinical Details

Reason for Referral *

Tooth / Teeth (URS notation if possible)

Clinical History & Notes *

Relevant Medical History

Urgency

Imaging Available

Upload Imaging & Files

Accepted formats: JPG, PNG, PDF. Please email files directly to info@amanphullendo.co.uk if large.

I confirm I have the patient's consent to share their details and that this referral complies with my practice's data handling obligations. Privacy Policy

Cases accepted

Referral Form

Not sure if a case is suitable?