For dental colleagues

Refer a patient

I accept referrals for complex restorative, cosmetic and implant treatment at Merivale Dental in Greenwich and Keppel Advanced Dentistry in Sutton.

Step 1

Send the referral

Complete the form below. Radiographs and clinical photographs can be attached.

Step 2

We contact the patient

The clinic's reception team contacts your patient to arrange a consultation at their preferred practice.

Step 3

You stay informed

I'll write to you with my findings and treatment plan, and keep you updated on the outcome.

Treatment I accept referrals for

Dental implants & soft tissue surgeryFull mouth rehabilitation Worn dentitionCrowns, bridges & onlays Porcelain veneersComposite bonding EndodonticsRestorative opinions

Referral form

Patient referral

Fields marked * are required. Fees are available on each clinic's website.

Referral details

Referral source *

Preferred practice *

Referring dentist

First name

Last name

Contact email

Practice name

Patient

First name *

Last name *

Date of birth *

Sex *

Address *

Email *

Contact number *

Referral

Services requested *

Consultation and opinion only Consultation and appropriate treatment Specific treatment (please specify below)

Reason for referral *

Any additional information that may be useful

Radiographs and/or clinical photographs

JPEG, PNG or PDF, up to 8MB in total. Larger files can be sent by replying to the confirmation email.

Privacy: information submitted is used only to arrange and provide the patient's dental care, is shared only with the chosen practice, and is never sold or passed to third parties. It is handled in line with UK GDPR.