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Dental Services
Refer To Us
Patients

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The Academy
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Dental Services
Refer To Us
Patients
About Us
The Academy
Contact
- Book Now

0117 450 2991

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REFER ONLINE
Book Now

You can refer a patient to Bristol Dental Specialists easily, quickly and securely using our Online Referral App. You can also include x-rays and clinical images with your referral. Simply click below to get started…

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Bristol Dental Specialists

Secure OnlinePatient Referral

Refer your patients easily, quickly and securely. You can also include x-rays and clinical images with your referral.

Referring Dentist Details

Date of Referral* Practice Name* Practice Address* Practice Address Line 2 Practice Town/City Practice County Practice Postcode Practice Telephone* Practice Email* Referring Dentist Name* Referring Dentist Telephone Referring Dentist Email* How would you like to be updated about this referral? PhoneEmailPost Do you have one of our Referral Packs? If so, do you need any more... Freepost envelopesReferral forms

Patient Details

Patient Title* Patient Name* Patient Address* Patient Gender* MaleFemaleOther Patient Date of Birth* Patient Home Phone Patient Mobile Phone* Patient Email* Patient doesn't have an email address or it is unknown How would your patient prefer to be contacted? PhoneEmailPost

Clinical Details

My patient's primary treatment requirement(please choose at the primary specialisms required):

My patient's additional requirement/s (please choose at as many specialisms as you believe are relevant):

RestorativeOrthodonticsDental ImplantsEndodonticsOral SurgeryPeriodonticsPaediatric DentistryRadiographyRadiographic ReportingComplete DenturesOther

OrthodonticsDental ImplantsEndodonticsOral SurgeryPeriodonticsPaediatric DentistryRadiographyRadiographic ReportingComplete DenturesOther

RestorativeDental ImplantsEndodonticsOral SurgeryPeriodonticsPaediatric DentistryRadiographyRadiographic ReportingComplete DenturesOther

RestorativeOrthodonticsEndodonticsOral SurgeryPeriodonticsPaediatric DentistryRadiographyRadiographic ReportingComplete DenturesOther

RestorativeOrthodonticsDental ImplantsOral SurgeryPeriodonticsPaediatric DentistryRadiographyRadiographic ReportingComplete DenturesOther

RestorativeOrthodonticsDental ImplantsEndodonticsPeriodonticsPaediatric DentistryRadiographyRadiographic ReportingComplete DenturesOther

RestorativeOrthodonticsDental ImplantsEndodonticsOral SurgeryPaediatric DentistryRadiographyRadiographic ReportingComplete DenturesOther

RestorativeOrthodonticsDental ImplantsEndodonticsOral SurgeryPeriodonticsRadiographyRadiographic ReportingComplete DenturesOther

RestorativeOrthodonticsDental ImplantsEndodonticsOral SurgeryPeriodonticsPaediatric DentistryRadiographic ReportingComplete DenturesOther

RestorativeOrthodonticsDental ImplantsEndodonticsOral SurgeryPeriodonticsPaediatric DentistryRadiographyComplete DenturesOther

RestorativeOrthodonticsDental ImplantsEndodonticsOral SurgeryPeriodonticsPaediatric DentistryRadiographyRadiographic ReportingOther

RestorativeOrthodonticsDental ImplantsEndodonticsOral SurgeryPeriodonticsPaediatric DentistryRadiographyRadiographic ReportingComplete Dentures

Preferred Clinician(please indicate if you wish your patient to be treated by a specific member of the Team):

DENTAL IMPLANT REFERRALS Adrian Watts ENDODONTIC REFERRALS Mohamed Elneklawy ORAL SURGERY REFERRALS Eithne Fyfe ORAL SURGERY / IV SEDATION REFERRALS Bosun Hong ORTHODONTIC REFERRALS Ben CrossClaudia RichardDarren Hills PAEDODONTIC REFERRALS Rebecca John PERIODONTIC/COMPLETE DENTURE REFERRALS James Ban Reason for referral*

Clinical Images

Consent and communication

Please note that any communication we send you will be secure. This confidential form is crucial for us to receive patient referrals. The details provided in this form must be accurate to the best of your knowledge and with the patient's full awareness and consent.

By submitting this form, we will securely gather and manage both your and the patient's information. Our handling of this data will strictly adhere to our Privacy Policy

As the referring clinician, I acknowledge and consent to the processing of my personal data.

I understand and agree to the processing of my personal data as the referring Clinician* I agree I have made my patient aware of this referral and the provision of their data for this purpose* I agree

Bristol Dental Specialists

Secure OnlinePatient Referral

What is 2 + 6 ?

Secure Online Referral

Our policies

Complaints procedure
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Data protection privacy notice
Terms of Business

Opening Hours

Monday 8.00am – 7.00pm
Tuesday 8.00am – 7.00pm
Wednesday 8.00am – 7.00pm
Thursday 8.00am – 7.00pm
Friday 8.00am – 5.00pm
Saturday By arrangement only
Sunday Closed

Contact us

Bristol Dental Specialists
‍24 Berkeley Square,
Bristol,
BS8 1HP

Phone: 0117 450 2991

Quick links

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Bristol Dental Specialists Ltd Registered in England & Wales company number 11696017

Bristol Dental Specialists, 24 Berkeley Square, Bristol, Gloucestershire, BS8 1HP. Telephone 0117 450 6666. Bristol Dental Specialists Ltd trading as Bristol Dental Specialists is a credit broker not a lender and is authorised and regulated by the Financial Conduct Authority, 914167. Registered in England & Wales 11696017. Registered Address: 24 Berkeley Square, Bristol, Gloucestershire, BS8 1HP.