Referrals

IN order for us to consult with you and determine the necessary treatment, we require a completed referral form listing the name/address of your dentist and reasons for referral.

Please complete the form below.

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Referral Form

PLEASE NOTE:

If radiographs are to be supplied, please note this in the reason(s) for referral box.
These should be delivered to the address below.

Fairoak Dental Practice
Portsmouth Road
Esher
Surrey KT10 9PJ

If you require a pdf of the form, please click button below.

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We aim to provide the highest standard of dental care for our patients.

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Our Services

Endodontics

Endodontics is commonly known as root canal treatment and provides the foundation for advanced restorative treatment.

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Orthodontics

Orthodontics is the branch of dentistry which specialises in the diagnosis, prevention and treatment of problems in the alignment of teeth and jaws.

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Periodontics

Periodontal treatment restores the supporting tissues surrounding the teeth to a healthy condition.

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Implants

Implants provide a safe, predictable and aesthetic solution to tooth loss that is a viable alternative to traditional treatments.

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General Practitioner

A general dental practitioner covers all aspects of general dentistry, provide the highest standard of dental care.

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Hygienist

A hygienist specialises in preventitive oral health. In working together with the dentist or periodontist, the hygienist is able to provide optimum oral care to the patient.

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