Patient Referral Form for dentists and doctors

Key information for first time users

If this is the first time you have used our patient referral form please click below to view key information for form users. If you require any further information about referral service or assistance completing this form please call 01242 655554 and speak to a member of the team.

Click here for key information about the referral service

Referral Guarantee

We value the trust you place in us to provide your patients with the best possible referral treatment and care.

To pledge our commitment to this we have written a referral guarantee that puts your interests and that of your patients first.

To view click referral guarantee in the sidebar


Data Protection

The information you provide here will be used solely for the purpose of referring your patient to Arnica Dental Care. A patient record will be created within our secure patient management system and a copy of this form scanned and added to patient notes.

WE WILL NOT share any information provided by you with any third party unless explicitly requested to do so in writing either by you – the referring GDP/GMC, or the patient.

For more information about how we protect your data and that of your patients please see
our Privacy Notice on our website www.arnicadentalcare.co.uk/privacy-notice.


What Happens Next

On submission you will recieve a copy of this completed form via email. Please keep for your records

A member of the Arnica team will then contact your patient to arrange an appointment.

You will be notified of the appointment date and time.

You will be notified when treatment is complete


Technical

To ensure that we are not caught out by the occasional technical glitch if a member of the Arnica team has not contacted you within 48 hours (2 working days) of completing this form please call us on 01242 655554


Notice for Patients

Please note failure by the patient to attend appointment will incur a £50 non-attendance fee.