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Gold's Place Dental


We aim to make referring a patient to us as simple as possible. Radiographs and photographs may be added to the online form, but are not essential.

Dentist Referral Form

Referral Form
  • Dentist Details
  • Patient Details

Dentist Details

Patient Details

Referral Charter

We understand the sensitive nature of referring patients for the more complex aspects of modern dentistry. Our team are here to support you and we make the following commitment:


• We will provide the highest levels of care for your patient.
• Treatment is only carried out as agreed with you.
• We always provide your patient with a full written treatment plan, including costs. We are happy to provide you with a copy on request.
• In the rare event that our treatments result in complications we will provide the follow up care required.
• We treat our patients as if they were a family member – we will do the same for your patient, before returning them to you for ongoing care.
• A successful referral to our practice will enhance your patient’s trust in you as their dentist and they will be grateful to you for referring them to us for treatment.