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Dentist Referrals

General Dentistry
We welcome your referrals to Lancashire Dental & Orthodontics. We look after patients:
  • A team that truly cares for them
  • A bespoke personal service
  • A full range of modern dental treatments
  • A comfortable, pleasant, enjoyable and relaxing environment
To refer your patient, you have three options:
  1. You can either fill in the Referral form below OR
  2. Download the Referral form, print it out, fill it in and then send to Lancashire Dental & Orthodontics
  3. Contact us on 01254 51579 or email info@lancashiredental.co.uk
1. MANUAL FORM FILL-IN To download the Sedation referral form Click Here To download the Orthodontics referral form Click Here To download the Dental Implants referral form Click Here 2. ONLINE FORM FILL-IN Please fill in as many details as you can. Fields which have this symbol * need to be filled in. Please note that when you click the SUBMIT Button at the bottom, all your details will be sent via email to Lancashire Dental & Orthodontics and are completely confidential. Keep scrolling down till you find the online form you want.

Orthodontics Referral

Referring Dentist Details

Treatment Required

Patient Details

By submitting this enquiry form, Lancashire Dental will securely collect your details. Please read our Privacy Policy on how we protect and manage your submitted data. You will be able to ask us for details of the personal data we hold on you, or ask us to delete it. We will never share your details with a third party.

* Required

Dental Implants Referral

Referring Dentist Details

Treatment Required

Patient Details

By submitting this enquiry form, Lancashire Dental will securely collect your details. Please read our Privacy Policy on how we protect and manage your submitted data. You will be able to ask us for details of the personal data we hold on you, or ask us to delete it. We will never share your details with a third party.

* Required

Sedation Referral

Referring Dentist Details

Treatment Required

Patient Details

By submitting this enquiry form, Lancashire Dental will securely collect your details. Please read our Privacy Policy on how we protect and manage your submitted data. You will be able to ask us for details of the personal data we hold on you, or ask us to delete it. We will never share your details with a third party.

* Required