Tel: 0117 9238 400 Fax: 0117 9467 007 Email: info@rootfillings.com

Make a referral

Please note the referrals page is for use by the dental profession only.

Please fill in the form and click on the 'Send Referral' button to send the information electronically to us.

Click here for a printable version of the referral form.

  • Dentist information

  • Patient information

    • Email:
    • Post:
  • Treatment information

    • Bad taste:
    • Bleeding:
    • Difficulty chewing:
    • Pain:
    • Recurrent abscesses:
    • Swelling:
    • Tooth mobility:
    • Yes:
    • No:
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