Make a referral

To refer a patient to City Bridge Dental & Implant Clinic, simply complete and submit the below referral form.

Please include all relevant clinical information regarding this case, and remember to attached any x-rays if relevant.

After reviewing, we will contact the patient to introduce ourselves and book them in. We will also keep you fully updated on progress throughout.

Patient details (step 1)

click to open click to close

Please check that the following fields have been filled out correctly:

    Referring Dentist Details (step 2)

    click to open click to close

    Please check that the following fields have been filled out correctly:

      Referral Details (step 3)

      click to open click to close

      General assessment of dental health

      Oral hygiene *

      - Please note that only the following file types are supported: jpeg, jpg, png, gif, pdf, doc, docx, xls, xlsx, rtf, ppt, odt.
      Add more files
      Other records sent via post
      Final restoration to be placed by:
      Confirmation

      Please check that the following fields have been filled out correctly:

        This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

        Portman Dental Care Awards

        Fmc Logo 2019 Winner Oby M25
        Dental Industry Award - Portman Dental Care
        Award Logo 2018
        Private Dentistry Awards - Portman Dental Care
        Elite Practice Award - Portman Dental Care