Referrals

Root canal, implants and dentures by Dr Matthew Gahan

Invisalign, CBCTs and aesthetics

Online Referral Form

We welcome referrals from our dentist colleagues to Dr Matthew Gahan for specialist root canal, implants and restorative cases including complex dentures. We also accept referrals for Invisalign, cosmetic dentistry and facial aesthetics. We also offer CBCT scans, but do not currently have the capacity to report on these.

Please complete the form below and we’ll contact you and your patient as soon as possible. Patients can also self-refer via this form.

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Referring Dentist Details

Full Name*

Contact Number*

Email Address*

Address*

Patient Contact

Name*

Contact Number*

Email Address

Date of Birth*

Address*

Patient Details

Medical Details*

Chief Complaint & Brief History*

Problem Tooth/Teeth*

Clinical Findings*

Treatment Requested

Dental Implants

Endodontics

CBCT Scan

Invisalign/Cosmetic Dentistry

Facial Aesthetics

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Radiograph Findings

Data Protection

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Referrals

Online Referral Form

Referring Dentist Details

Patient Contact

Patient Details

Data Protection

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