Dentist Patient Referral Form


With a reputation for the highest quality patient care, over 300 local dentists refer their complex cases to us. If you need to refer a patient to us, please enter full details on the form on the right.

We promise to only carry out treatment for which they have been referred to us and always return your patients back to you. You will be kept informed throughout the referral process and during your patient’s treatment. A comprehensive report will be sent to you after the initial consultation.

You can also refer by fax, by mail or even by telephone and referral-letter packs are available from the practice. Any radiographs that you can provide will minimize patient’s costs. All treatment charges will be thoroughly discussed with the patient and a written estimate given, so there is no chance of any misunderstanding.

We are here to support and mentor you with our team of highly qualified dental specialists. We provide regular training events – contact us for further information.

If you have any questions or concerns, please contact us.


You can write to us at

Mount Vernon Dental Specialists
Gate One
Mount Vernon Hospital
Rickmansworth Road
Middlesex, HA6 2RN
Tel: 01923 840 571
Fax: 01923 845 890