REFER YOUR PATIENT FOR DENTAL CARE IN THE VALE OF GLAMORGAN

We welcome referrals at Vale Dental Centres for the following treatments:

Dental Implants
CBCT Scanning
OPG X-Ray
Root Canal Treatment
Composite Bonding
INVISALIGN / Clear Orthodontic Aligners

If referring a patient to Vale Dental Centres, please fill out the following referral form so we can arrange your appointment as soon as possible. If you prefer, you can also download a paper referral form or call us directly.

Patient Information

Patient Name:

Patient Date of Birth:

Patient Address:

Patient Contact Number:

Patient Contact Email:

Referral details (treatment aims):

Relevant Medical History

Document Upload

Please upload any files that may be necessary.

Click or drag files to this area to upload

Referrer Details

Your Name:

Practice address

Referrer Contact Number:

Referrer Contact Email:

What are you looking to refer:

Implant Treatment

CBCT Scanning

OPG X-Ray

Root Canal Treatment

Composite Bonding

INVISALIGN / Clear Orthodontic Aligners

Other

To whom do you wish to refer your patient?

Referrals

REFER YOUR PATIENT FOR DENTAL CARE IN THE VALE OF GLAMORGAN

Patient Information

Document Upload

Referrer Details