Orthodontic referrals

Your trusted referral partner

When you make a referral with St Michael’s Orthodontics, your patients will receive first class dental care – and will only be treated for what they have been referred to us for. By working together, we can complement your existing dental services and broaden the range of treatments you offer to your patients.

To discuss a referral

We’ve been seeing referred patients for over 30 years, so we’re experienced at managing these relationships. If you would like to discuss a patient with our specialist orthodontists, please call us on 01924 380680 to arrange a time that is suitable for you and our clinicians. We guarantee everything you share with us remains in the strictest confidence.

To make a referral

Our highly experienced and skilled orthodontists accept referrals for private orthodontics. If you would like to refer a patient for private orthodontic treatment, please fill in the form below. Once we have received your referral, we will contact your patient to introduce ourselves and book them in. We’ll keep you fully updated throughout the process.

Make a referral

Patient details (step 1)

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First name *

Last name *

Address 1 *

Address 2 *

Postcode *

Date of birth *

Contact number *

Email *

Please check that the following fields have been filled out correctly:

Next stage

Referring Dentist Details (step 2)

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First name *

Last name *

Phone number *

Practice name *

Practice address line 1 *

Practice address line 2

Practice city *

Practice county *

Practice postcode *

Email address *

Please check that the following fields have been filled out correctly:

Next stage

Referral Details (step 3)

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Enter the name of the relevant clinician to refer your patient to (if known)

Treatment required *

Please select... Teeth straightening Ceramic braces Fixed metal braces Invisalign clear aligners Retainers

Observations & Dental History

General assessment of dental health

Oral hygiene *

Poor Fair Good Other

Teeth of poor prognosis *

Relevant medical history *

Additional files
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Any comments

Confirmation

  I confirm I have the requisite authority to share the patient's information in connection with this referral

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