Form - Extraction Referral - Wooding Dental Group

Surgical Extraction Referral

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

Fees include:

Assessment: £40

Surgical extraction: from £325

Surgical extraction of wisdom tooth: from £495

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.

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

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