Twenty 2 Dental
22 Milton Road, Weston-Super-Mare,
Somerset, BS23 2SL
Twenty 2 DentalCosmetic & Implant Dentistry - Changing Lives With A Smile
Call us: 01934 620220
For a FREE implant, cosmetic or orthodontic consultation!

For Referring Dentists

Professional Referrals

downloadWe are are happy to accept referrals from colleagues for:

You can complete the on-line referral form below or download a form to send by post or fax (01934 620567)

Please call us to arrange an appointment for your patient on 01934 620220 or we can contact the patient directly for you if you prefer.

CBCT Imaging Services

Patient referral could not be easier. Simply download the CBCT imaging referral form for Twenty 2 Dental Imaging and return it to us by email, fax or post. We also accept referral letters on headed paper that contain the following information: referrer contact details, patient’s name and date of birth, the area of interest and, most importantly, the type and purpose of examination.

Please click for details of our CBCT referral page.

Click to view a PDF of our Twenty 2 Dental CBCT Referrals

Patient Referral Form

Please note, all fields marked with * must be complete before the form can be sent.

Referring Dentist:
Please list treatment(s) you are referring:*
Post Code:*
Name:*
E-mail Address:*
Practice:*
Work Telephone Number:
Address:*
Mobile Telephone Number:
Patient Details:
Title:
Address:*
Name:*
Post Code:*
D.O.B:*
Telephone Number:*
Referral Reason:
Implant/s
Restorative
Periodontics
Endodontics
Orthodontics
Multi-disciplinary
Referral Details:
This Patient:
Patients Complaint/Reason for Referral:*
Class:
Tooth/Teeth to be treated/Replaced:
If appropriate I am happy to carry out:
Other relevant information:
Please give details of any attachments to this form, e.g. radiographs etc, and attach using the form below:
Contact Us
Call Us