Dental Implant Referral

At Barns Dental Practice, we welcome referrals from fellow dental professionals for patients in need of dental implants. Implants provide a long-lasting, natural-looking solution for missing teeth—enhancing both oral health and overall quality of life.

To refer a patient, simply complete the form below with the relevant details. Our experienced team will review the referral promptly and contact your patient to arrange a thorough consultation.

Referral Form

"*" indicates required fields

Referring Dentist's Details

Name*

First Last

GDC Number

Practice Name and Address*

Street Address Address Line 2 Town Postcode

Contact Name*

Email*

Referring Dentist ID No (optional)

Patient's Details

Name*

First Last

Address*

Street Address Address Line 2 Town Postcode

Date of Birth*

Contact Number*

Email Address*

Proposed Treatment Plan:*

Please include any relevant file attachments such as Radiographs, Clinical Notes or Photographs. (optional)

Drop files here or

Max. file size: 12 MB.

Data Protection*

Please confirm you have read and agree to our privacy policy before submitting this form.