Referrals

For our dental colleagues, it is our absolute commitment that all patients referred are returned to their dentist once they have been discharged from our care.

Please select how you would like to refer:

Online

By Email

By Post

REFER TO US BY ONLINE

This form below is for the convenience of dentists who wish to refer patients to one of our team members for specialist treatment

Please inform your patient that we ask for a deposit (except for free consultations) that is transferable with 48hrs notice for all of our appointments. The deposit is then deducted from the cost of the treatment.

ENTER YOUR REFERRAL DETAILS BELOW:





Patient Details

  • I am referring the patient for:
    Select at least one.
    PeriodontistOrthodontistOther
  • Other(Please specify):

    1. Patient Name:
    2. Patient’s preferred phone number:
    3. Patient’s Address:
    4. Patient’s Date of Birth
    5. Patient’s email address:



    REFERRING DENTIST’S DETAILS


    1. Your Name:
    2. Your Phone number:
    3. Your Email address:
    4. Practice Address:
    5. Detailed reason for referral / Case Description:
    6. Please upload relevant images/radiographs :
    7. Referral Date:

    REFER TO US BY EMAIL

    Please kindly attach digital x-rays and photo’s that you feel appropriate along with either a covering letter or a completed scanned copy of our referral pro-former.

    Click here to download the referral pro-forma

    Please click here to email us on or use contact@broadwaydentalstudio.co.uk

    Please click here to email the referral centre.

    REFER TO US BY POST

    Please complete referral pro-former (click here) and enclose any hard copies of radiographs/photographs you feel appropriate.

    Our address is:

    Broadway Dental Studio Mill hill

    Flat 1 Broadway House

    36-38 The Broadway

    Mill Hill

    NW7 3LJ’

    Emergency appointments within 24 hours and are open

    Tues/Wed/Fri 8:30am to 5:30pm
    Mondays/Thursdays - 8:30am to 8:00 pm Tuesday/Wednesday - 8:30am to 5:30pm Fridays - 8:30 am to 1:30 pm (afternoons by prior arrangement only) 2 Saturdays a month

    Broadway Dental Studio

    Copyright Broadway Dental Studio 2022. All rights reserved.