ORAL SURGERY
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Oral Surgery
Location
London Locations
Wessex Locations
Contact
For Dentists
Private Referrals
Sedation Services
NHS London Referrals
NHS Wessex Referrals
Education
Home
About
Treatments
Oral Surgery
Location
London Locations
Wessex Locations
Contact
For Dentists
Private Referrals
Sedation Services
NHS London Referrals
NHS Wessex Referrals
Education
We welcome private referrals from our colleagues for all aspects of Oral Surgery, Dental Implants & Sedation. Please use the form below or you can submit your referral by
email
or by post to Oral Surgery Ltd, 30 Ashley Road, Bournemouth, BH1 4LH.
Private REFERRAL FORM
Referrer details
*
Indicates required field
Dentists Name
*
Practice Email
*
Practice Tel.
*
Practice Address
*
PATIENT DETAILS
Patient Name
*
Patient Email
*
Patient Tel.
*
Patient Address
*
CLINICAL INFORMATION
Treatment Requested
*
Preferred Location
*
Wessex
London
Preferred Surgeon
*
No Preference
Samy Darwish
Abdel Tawfik
Sami Stagnell
Tarik Shembesh
Other
Choose Any
*
Check this box if radiographs are not available
Declaration
*
Please tick this box to confirm that you have discussed this referral with the patient and they have agreed for you to share their personal information in line with the General Data Protection Regulations 2018
Submit