Dentist referrals

If you are a dentist who is looking to refer your patient(s) for private orthodontic treatment in Surrey, please fill out the form below. We look forward to working closely with you to protect the health of your patients’ smiles.

Dentist referrals

New patient referral form

Please fill out the forms below to refer your patient for treatment with braces or clear aligners. We thank you for your referral.

This online referral form is for dentists to refer PRIVATE patients only.

Dentist's details

Patient's details

For further information about how we use your data, please see our privacy policy.