Root Canal in Manchester

I’m a Dentist, I wish to refer a patient

Please provide the below details and email to: endo@endodontistmanchester.co.uk

• Referring Dentist Name
• Referring Dentist Email
• Referring Practice and Address
• Reason for Referral
• Patient Name and Title
• Patient Address
• - Street Address
• - City
• - Postal Code
• Patient Contact Number 1
• Patient Contact Number 2
• Patient Email
• Patient Date of Birth
• Additional Details/Requests
• Attach Radiographs

I’m a Patient, I wish to self-refer

• Please note, it is strongly advised to get a dentist/emergency dentist to refer your case to us (you may wish to direct them to this website)
• To avoid duplication, please do not self-refer if your dentist has already agreed to send in a referral for you
• If this is not possible, please include the below details and email to: endo@endodontistmanchester.co.uk
• Please make your best efforts to request Radiographs of the problematic tooth from your dentist/emergency dentist for your self-referral.
• Patient Name and Title
• Patient Contact Number 1
• Patient Contact Number 2
• Patient Email
• Patient Address
• Patient Date of Birth
• Tell us a bit more about the problematic tooth (past or current symptoms)
• Medical Conditions and Current Medication
• Additional Specific Requests
• Attach Radiographs
• Routine Dentist’s Name (if applicable)
• Referring Dentist’s Email (if applicable)
• Referring Practice and Address (if applicable)

Dentist Referral Form

Patient Referral Form