Referrals

We are delighted to accept referrals for a range of treatments, including Dental Implants, Invisalign and Enlighten Whitening, as well as providing second opinions from our experienced LeoDentists.

Our brand new, state of the art CBCT scanner allows our clinicians to see all the information they need to expertly plan your treatment. We use this advanced technology so that we can be sure your implants will be placed in exactly the right position without encroaching upon any nearby nerves and structures. We also provide CT scans for many other dental practices in London.

If you are interested in referring a patient to LeoDental, please submit the online referral form below or feel free to call us and speak to any of the LeoDentists.

Click here for Speciality Referral

Click here for CT Scan Referral

CT Scan Referrals

Patient Details:

Full Name *

Patient’s Date of Birth *

Patient contact details. These are the details we will use to contact your patient and ensure that they are booked in as smoothly as possible.

Patient’s Prefered Contact Telephone No. *

Patient’s E-Mail *

Please indicate which of the following you are referring for:

For 3D CBCT Scan Please Indicate Area of Interest

Both Jaws

Mandible (lower Jaw)

Maxilla (Upper Jaw)

Please indicate the exact teeth required

Panoramic X-ray

Please give details of justification for CBCT Scan or Panoramic X-ray.

Radiography report (please select) *

All Digital Panoramic and CBCT Scans will be provided on a USB Pen with the Viewing Software provided complimentary by LeoDental for our referring dentists.

Please enter your practice details:

Practice Name *

Practice Address *

Practice Email *

Practice Telephone No. *

Please enter the referring practitioner details:

This will act as the signature, hereby authorising The Smile Practice to carry out a 3D CBCT Scan or Panoramic x-ray on your behalf.

Full Name *

Any additional comments

Payment made by: (please select from dropdown) *

Referrals

Please indicate which of the following you are referring for:

Patient Details:

Please enter your practice details:

Please enter the referring practitioner details:

CT Scan Referrals

Patient Details:

Please indicate which of the following you are referring for:

Please enter your practice details:

Please enter the referring practitioner details:

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