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Endodontics Referral

Arvind Sharma Endodontics in Edinburgh

BDS (Dundee), MSc (Endodontology), MJDF RCS (Eng), MFDS RCPS (Glas)

Please complete the form below for an Endodontics referral to our Edinburgh clinic. Thank you.

ENDODONTICS FEE GUIDE

Referring Practitioner

Name

Date

Address

Postcode

Phone

Patient Details

Name

Date of Birth

Address

Postcode

Phone

Reason for Referral

Treatment Requested:

Referral Notes

Preferred Post-op. Restoration:

Temporary

Composite Core

Fibre Post/Core Build-up

Radiograph

Radiograph enclosed (Digital radiographs can be sent to endo@newlifeteeth.co.uk)

Please upload an X-ray attachment, if available.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf.

X-ray attachment

Leave this field blank

Arrange a consultation > or give our Edinburgh clinic a call on 0131 564 1822 or our Belfast clinic on 0289 521 7533

Get in Touch

Call us today to make an appointment or get in touch regarding any other queries you may have.

Edinburgh: 0131 564 1822

22 West Tollcross, Canal Point, Edinburgh EH3 9QW

Belfast: 0289 521 7533

743 Lisburn Rd, Belfast BT9 7GW

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Last updated: 07.07.2021 11:33:39

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