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Referring Dentists

Referring Dentists








    Please Indicate

    Treatment Needed

    Tooth Number

    Crack Tooth/ Pain Assessment

    Root Canal Treatment

    Root Canal Retreatment

    Post Core Composite

    Apicoectomy

    X-Ray attached (1 X-Ray attachment allowed)

    not more than 5mb


    (For referring dentist, a copy of the online referral will be sent via the clinic email provided)