Make a referral

To refer a patient to Orchard Dental & Implant Clinic, simply complete and submit the below referral form.

Please include all relevant clinical information regarding this case, and remember to attached any x-rays if relevant.

After reviewing, we will contact the patient to introduce ourselves and book them in. We will also keep you fully updated on progress throughout.

We are happy to receive patient referrals from other dentists for:

  • Dental implants
  • Root canal treatments
  • Gum disease
  • Nervous patients & oral sedation 
  • Veneers
  • Cosmetic dentistry

For CBCT scan referrals, please contact Orchard Dental & Implant Clinic on 01628 620764 or complete our below form.

Choose referral

Your details

Patient details

General assessment of dental health

Oral hygiene *

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Portman Dental Care Awards

Fmc Logo 2019 Winner Oby M25
Dental Industry Award - Portman Dental Care
Award Logo 2018
The Dentistry Awards - Portman Dental Care
Private Dentistry Awards - Portman Dental Care
Elite Practice Award - Portman Dental Care