[siteorigin_widget class=”SiteOrigin_Widget_Hero_Widget”][/siteorigin_widget]

    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:


    Name *

    Date of birth

    Home address *

    Mobile number*

    Home telephone*

    Work telephone *

    Email *

    Dentist Details

    Practice *


    Dentist *

    Business email *

    My patient is being referred for:


    Oral Surgery




    Zoom Whitening


    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