Dental Implant Treatment Referral Form for Dentists

121 Harley Street, London W1G 6AX. Tel: 0207 486 5538

Preferred contact: (Patients will be contacted within 4 hours of referral)



Type of treatment:

1. Consult and Opinion Only
2. Single tooth Implant placement - Dentist restores Ankylos Implant
3. Placement and restoration
4. Multiple tooth Implants
5. Advanced Bone grafting or Sinus Augmentation
6. Minor Oral Surgery
7. Full Arch Reconstruction


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0207 486 5538
121 Harley Street

Our aim is to ensure both referred patient and referring dentist are delighted with the quality of our clinical expertise and level of care and attention that we provide.

Following treatment we will always return the patient to the referring dentist.

We will only carry out the treatment agreed with the referring dentist.

We will always provide the patient with a written treatment plan, estimates of fees and a copy of these will always be sent to the referring dentist