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: 0161 830 7300
Fax: 0161 830 7301
Email: info@malldental.com

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:*

referral details patient name*

patient address*:

patient telephone*

patient birth date*

brief nature of referral:

relevant medical history:
(a full medical history
(will be taken):

relevant dental history:
(a full history
(will be taken):

Mall Dental, Pall Mall, Manchester, Greater Manchester, M2 4DU, UK 0161 830 7300