How To Refer — MA-Endo

Referrals

The best way to refer is to complete the form below, alternatively you can send an email to info@letchworthdentalsurgery.com for referrals within and around Hertfordshire or info@thurmastondental.co.uk for referrals from The Midlands. Please include basic patient details, contact information, relevant medical history, signs and symptoms of the problem along with a periapical radiograph of the tooth in question.

Your patient will be contacted to arrange a consultation appointment at the practice, the treatment procedures will be discussed and once agreed upon a treatment appointment will be made.

After obturating the root canal system, the canal orifices will be sealed with a Zinc Oxide Eugenol restoration followed by a GIC core. The patient will be discharged back to your care for a definitive cuspal coverage restoration. Patients will not be seen for routine dental treatment.

Referring Dentist

Practice Address

Practice Telephone Number

Practice Email

Patient's Name

Patient's DOB

Patient's Address

Patient's Contact Number

Patient's Email

Reason for Referral/Details of the Problem

Upload Image (Please place patient's name below as reference) Click Here