Dentist Referrals

We are honored that you are looking to refer your dental patient for treatment with us. We promise to always discuss your patient’s treatments with you in advance, and use the best quality materials and evidence-based techniques to help them achieve a smile they’ll love.

Please complete our dental referral form to assist us in a smooth and efficient service for you and your patient. All relevant clinical information will be kept strictly confidential.

Referring practitioner

Patient details

Chief complaint and additional details

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Expertise

Our aim is to ensure both you, the referring dentist (where applicable), and your patient are delighted with the quality of clinical expertise and the level of care and attention provided by us. We will always use the best quality materials and evidence-based treatments with a proven track record.

Trust

We will only carry out the treatment previously agreed with you, the referring dentist (where applicable). If we feel other treatments are necessary, this will always be discussed with you first. We appreciate the trust you / your dentist have placed in us and we will endeavour to provide the same high standard that you would expect.

Choice and consent

After the initial consultation, we will always provide a written treatment plan, a copy of which can also be sent to the referring dentist.

Care

In the rare event where complications arise while the patient is under our care, we will always ensure that they receive any remedial treatment they require immediately. The patient will always be returned to the referring dentist for any non-orthodontic treatment.

Support

Our aim is to ensure that as part of an extended dental team, we can add value to the overall patient experience. We will support you / your patient every step of the way. We are happy to provide advice and guidance at any stage.

Please complete the form:

To assist us in a smooth and efficient service for you and your patients, please complete the details on this page as fully as possible. All relevant clinical information will be kept strictly confidential.

British Orthodontic Society

British academy of cosmetic dentistry

American association of Orthodpontists

British Dental Association

General Dental Council

Royal College of Surgeons of England

The Royal College of Surgeons of Edinburgh

Find us

  • Edgbaston Medical Quarter (opposite The Physician Pub)
  • Near City Centre and Five Ways
  • Free parking

Signature Orthodontics

38 Harborne Road, Birmingham, B15 3HE

0121 454 7011 Find us