Our Glasgow practice is now accepting referrals for Sedation under NHSPatient informationTitle * Mr.MissMrsMsDr.Other Practice * Please select....GlasgowCambuslang First name *Last name * Address * Contact details DOB * X-rays/Any other relevant files enclosed? *YesNo Please attach all relevant files:Upload Images:Upload Images:Upload Images:Upload Images:Upload Images:Upload Images:* File uploads are limited to 30mb Type of referral *Implants(X-rays should be provided)Orthodontics(X-rays should be provided)Other Surgical Procedure(X-rays should be provided)Private Surgical Extraction - with Sedation(X-rays should be provided)Private Surgical Extraction(X-rays should be provided)NHS Restorative - with sedation(X-rays should be provided)Private Restorative - with sedation(X-rays should be provided)Please tick all boxes that applyTreatment required * Has the patient been referred before? *YesNo Any relevant medical history? *YesNo Please list all relevant history:Referring Practitioner Details *By clicking ‘send’ you are consenting to us replying, and storing your details. (see our privacy policy).
