Dental Referral Form

    Referred by:

  • Patient Details:

  • Date of birth
  • Possibility of pregnancy
  • Payment: (Consultation fee £125)

    • Account to referrer
    • Patient to pay
  • Medical Insurance complete details

  • Treatment Required

  • Dental Implants
    Oral Surgery
    I.V Sedation
    Orthodontist
    Hygienist
    Endodontics
  • Region of Interest:

    • Lower jaw
    • Upper jaw
  • I’d like to be informed of exclusive offers and other practice information
    YES

    *By clicking ‘submit form’ you are consenting to us replying, and storing your details. (see our privacy policy).





Services

We offer a wide range of dental treatments.

More Information

Send us a message now. We look forward to hearing from you.


I am looking for a new dentist
I have a dental emergency
I would like to know more dental implants
I would like to know more teeth straightening
I would like to know more about cosmetic dentistry and facial aesthetics
I would like to know more about dentures

I’d like to be informed of exclusive offers and other practice information YES
*By clicking ‘send message’ you are consenting to us replying, and storing your details. (see our privacy policy).

01865 951861 info@thewhitebridgeclinic.co.uk
Opening Hours
Day
Hours
Monday
Closed
Tuesday
10:00am – 6.30pm
Wednesday
9:00am -5.30pm
Thursday
9:00am – 5.30pm
Friday
8:00am – 4.30pm
Saturday
9:00am – 4.30pm

Fast train links into London, on site parking & disabled access

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