Dental Referral Service at Belfast Dental Clinic, Northern Ireland

97 Brunswick Road Bangor
Call : 028 9127 0634

Email Us | How to Find Us

15 Windsor Avenue Belfast
Call : 028 9038 1822

Email Us | How to Find Us

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Cranmore accepts referrals from other dentists and dental practices.

To make a referral, download and print our new PDF Referral Form.

Alternatively, use the email form below.

Please be assured that we will neither approach nor accept your patient for non-referred treatment.

97 Brunswick Road
Bangor
County Down
BT20 3DW

T : 028 9127 0634 F: 028 9127 2635

15 Windsor Avenue
Belfast
County Antrim
BT9 6EE

T : 028 9038 1822

Fields in bold are required.

Practice details

Patient details

Patient Name :

Date of Birth. :

Patient Address :

Mobile :

Tel Home :

Tel Work :

Email :

Is this referral urgent?

Yes No

Referral Information (Please tick all relevant boxes)

Resons for referral

Implantology

	Full mouth reconstruction
	Implant assessment, placement & restoration
	Implant placement & refer back for restoration
	Bone Graffs (sinsu, block, GBR)

Referral for Opinion only?

Yes No

Treatment?

Yes No

Affected areas

Upper Lower Both

REFERRAL INFORMATION

DIAGNOSTIC AIDS (Please tick all relevant boxes)

OPG PA’s Other Radiographs

Please be assured that we will neither approach nor accept your patient for non-referred treatment.

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Dental Referral Service at Belfast Dental Clinic, Northern Ireland