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Woodlands Dental & Implant Centre

Refer a patient

We accept referrals for endodontics and dental implant treatment. To refer a patient simply complete the secure form below and we will get back in touch with you.

    Your details

    Tell us who you are


    Patient Details

    Tell us the patients details

    Patient Gender

    Patient's Email*

    Refer For

    Dental ImplantsEndodontics (Root Canal Treatment)InvisalignPeriodontist (Gum Specialist)Digital Impression (iTero)2D Panoramic X-ray (OPG/DPT)CBCT (3D x-ray)

    Is the patient coming with a radiographic template?

    YesNo


    IF CBCT

    The following section is only required for CBCT patients

    CBCT Area of Interest




    Low Dose CBCT?

    (usually used for post-op scans as lower resolution)

    I would like to receive periodic communications from Woodlands Dental Practice about products and services that might be of interest to me.

    Your details
    Tell us who you are

    Patient details
    Tell us the patients details

    IF CBCT
    The following section is only required for CBCT patients

    If at any time you would like to withdraw consent for receiving marketing communications from us, you can do so by emailing or telephoning the practice, or telling us in person at the practice. We will only use this information for communicating with you about your dental care, oral health and any of our services that we feel may be of interest to you.

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