Dentist Referral Form

Dentist Referrals.

At Visage Orthodontics, we’re always happy to welcome referred patients. With three experienced orthodontic consultants on our team, we ensure every patient receives expert care and attention.

We’re proud to maintain a consistent NHS patient waiting time of just 2 to 4 weeks. Our focus is on providing timely, high-quality treatment in a supportive and professional environment. We value the trust our dental colleagues place in us and are committed to delivering excellent outcomes for every referral.

Patient Details

Full Name

Date of Birth

Phone Number

E-Mail Address

Post Code

Parents Guardian Name (if patient is under 18)

Reason for Referral

Type of Referral?

NHS Private

Is it urgent?

Yes No

Dentist Details

Dentist Name

Practice Name

E-Mail Address

Patient Consent

Your patient must consent to the provision of their details to Visage Orthodontics Aberdeen, and must understand what their details are being used for. Your patient can review the referral patient privacy policy at any time, and can request their details are removed.

I confirm that the patient (or patient’s parent or legal guardian) consents to the provision of their personal data.

Dentist Referrals.

Get in Touch.

Quick Links.

Opening Hours.

Dentist Referrals.

Get in Touch.

Quick Links.

Opening Hours.

Please complete the form below, and our friendly team will be in touch soon.

Visage Orthodontics