Any photographs or radiographs are appreciated but not required. These can be added to your referral at the end of this form
Please only use this form for private orthodontic referrals.
NHS referrals can be made via Rego when available.
Please note patients must be 18 years or over and we are not able to offer inhalation sedation.
Please send radiographs wherever possible. These can be added to your referral at the end of this form.
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