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Referrals

We welcome referrals of dental patients. Please send us their details using the form below.

Dentist Details

Dentist Name
*
Practice Phone Number
*
Practice Name
GDC Number
Dentist Email
*
Clinic Address
County
Eircode

Patient Details

First Name
*
Surname
*
Date of Birth
*
Email
*
Mobile Phone Number
*
Home Phone Number
Address
*
County
*
Eircode
*

Referral Details

Referral Reason
*
Other Referral Reason
*
Upload Radiographs
Upload Clinical Photos
Further Information
*
Relevant Medical and Dental History
*
Success

Your referral has been received. We will be in touch with any questions.

If you need to contact us for any reason, you can find our contact details here.

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Dental Council of IrelandAmerican Association of OrthodontistsIrish Dental Association LogoWorld Federation Of Orthodontists Affiliate AssociationRoyal Australasian College of Dental Surgeons LogoOrthodontics Society of Ireland
Dental Council of IrelandAmerican Association of OrthodontistsIrish Dental Association LogoWorld Federation Of Orthodontists Affiliate AssociationRoyal Australasian College of Dental Surgeons LogoOrthodontics Society of Ireland