Comfort Dental

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Online 01609 779 247

Northallerton

Endodontic referrals

At Comfort Dental we are happy to accept patient referrals from other dentists for endodontic treatment. Please fill in the referral form

About your practice

Your Name

Your Practice

Your Phone

Your Email

About your patient

Patient Title

Patient Name

Patient Phone

Patient Email

Patient Date of Birth

Please tell us about your referral

Please describe why you are referring this patient to us

Which teeth are affected?

Supporting photos and/or radiographs

Important: please keep all your photos and/or radiographs under 1MB and in BMP, PNG, JPG, GIF or PDF format to ensure we can receive them.

Important: if you have attached photos and/or radiographs please wait for this form to send before closing this page, it may take a few minutes depending on the speed of your internet connection.

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