Specialist Private Dental Care in Kent - dental implants & root canal treatment

Referrals

SPECIALIST REFERRAL FORM

Andrew aims to support practices in the area undertaking complex treatments such as implants, endodontics, periodontics and prosthodontics. As a GDC registered specialist in Restorative Dentistry and the Restorative Mono-specialties Andrew is able to provide unbiased treatment plans and treatment to a high level.

Andrew strictly treats only what has been referred to him, on completion he hands your patient back to you for continuing care.

Please complete all the required information on the form below and submit it. We will contact you within 24 hours to confirm receipt.

Specialist Referral Form

Patient First Name *

Patient Surname *

Patient Address *

Address Line 1

Address Line 2

City

County

Postcode

Patient Date of Birth

Phone

Patient Mobile number

Name of Referring Dentist *

Dentist's Email address

Dentist Phone Number

Dentist Address Line 1

Dentist Address Line 2

City

County

Postcode *

Reason for referral *

Dental implants - placement and restoration

Dental implant placement only - new referrers will be contacted for training

Dental Implant Failures

Endodontics - including complex anatomy, retreatment, traumatised teeth, resorption, separated files, surgical endodontics

Periodontics - including non-surgical therapy, surgical therapy, periodontal surgery , regenerative surgery & mucogingival surgery

Prosthodontic - Removable - including implant bar & attachment overdentures, complete dentures & cobalt chromium dentures

Prosthodontic - Fixed - including oral rehabilitation, tooth surface loss, veneers and failing dentitions

Referral Notes *

File attachment

Please CLICK include any relevant file attachments such as radiographs, clinical notes, STL files, or photographs (If more than one please click below).

Upload

Attachment 2

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Attachment 3

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Attachment 4

Service would like us to provide *

Any comments

Contact

Mr Andrew RJ Elder

Private Patients

C/o Maxillofacial Department

William Harvey Hospital

Ashford

Kent TN24 0LZ

Tel: 01233 220322

Email: info@andrewelder.co.uk

Mr Andrew ELDER BDS MFDS FDS (RestDent) RCS Eng SPECIALIST IN RESTORATIVE DENTISTRY | PERIODONTICS ENDODONTICS | PROSTHODONTICS

Specialist Referral Form

Mr Andrew ELDER BDS MFDS FDS (RestDent) RCS Eng
SPECIALIST IN RESTORATIVE DENTISTRY | PERIODONTICS
ENDODONTICS | PROSTHODONTICS