dentist referrals

The Mall takes on referrals for Orthodontics, Periodontics, Endodontics, Prosthodontics and Oral Surgery. If you would like to refer a patient to us please contact us.

The Mall
Pall Mall
Manchester
M2 4DU

Tel:
Fax:
Email:

0161 830 7300
0161 830 7301
info@malldental.co.uk

Alternatively, please use the online referral form and then post other relevant details and x-rays.

online referral form

*Indicates required fields

referral dentist details
dentist name: *
practice name: *
practice address:
practice postcode:
practice telephone:
practice email: *

patient details
name:
date of birth:
address:
postcode:

referral details
brief nature of referral:
relevant medical history: (a full medical history will be taken)
relevant dental history: (a full history will be taken)

dentist referrals

online referral form

referral dentist details

patient details

referral details