Form - Endodontic Referral - Wooding Dental Group

Endodontic Treatment Referral

Fill in all of the relevant fields and click submit to complete your referral request.

Fees include:

Incisors – FROM £445

Pre-molars – FROM 595

Molars – FROM 745

Full name

Date of birth

Address (with postcode)

Contact number

Email address

Radiograph - Please include a recent Periapical X-Ray which extends at least 2mm beyond the apex of the tooth in question.

Clinical reason for referral. Please detail reason for referral and any relevant history – including any complicating patient factors.

Please detail if you are happy for Limewood Dental Care to provide a restoration (crown/on-lay/etc) after the endodontic treatment, or if you would like the patient to return with ONLY a core-filling? (What core filling material would you prefer?)

Additional information - medical history, medication(s) or allergies.

Referrer details - Name, GDC number, practise address, telephone number & email address.