Elmfield House Dental Practice Referral Form
PRIVATE TREATMENT REFERRAL AGREEMENT
- Any patients referred to us by you will only be given the treatment that you have requested us to do. For any further treatment, (Maintenance, Root Canal Treatment, Fillings and any restorative work) the patient will be referred back to you, unless you advise us to carry out this treatment.
- For every referral, we will write back to you both at the beginning and at the end of treatment. We will forward relevant radiographs to you.
- We will always emphasize to the patient the need to see you for Routine Dental Check-ups and for any Emergency Treatment
- We will always be very happy to discuss with you the treatment plan and the future management of any case