Quick Enquiry

We constantly strive for excellence in our clinical and customer care standards

If you would like to refer a patient to us, you can either download our form to fill in and send to us or you can submit your referral online.

Our experienced team of friendly highly trained and caring professionals will ensure that you receive maximum attention with our personal touch.

The Centre is ideally located in the small village of Hampton Wick a short walk from Kingston Town Centre and close to Teddington High Street.

Click here to download a Referral Form

Online Referral Form

Fields marked with an * are required.

Patient Details:

Title

Name *

Date of birth

Home address *

Mobile number*

Home telephone*

Work telephone *

Email *

Dentist Details

Practice *

Address*

Dentist *

Business email *

My patient is being referred for:

 Periodontics

 Oral Surgery

 Hygiene

 Endodontics

 Invisalign®

 Zoom Whitening

 Implants

 Cosmetic Surgery

 Facial Aesthetics

The reasons for my referral are

Additional information about my patient

Medical history details

 My patient requires oral sedation/intravenous sedation

 My patient may need interest free credit

 My patient is covered by private insurance