Referrals to Our Team

Dentist Referrals or Patient Self Referrals

As part of the referral management service, we make sure that patients are seen in the most appropriate healthcare setting for the type of care they require. The referral will be assessed by a clinician who will take the information provided by your dentist into account, in order to determine where the problem is located.

Our referral form allows both dental professionals and patients to refer into Thornbury Dental Wellness with ease. This form helps us gather the information needed to assess your needs efficiently. Once received, our team will review the referral and contact you to discuss the next steps, ensuring a smooth and supportive referral process from the outset.

Dentist Details (if applicable)

Dentist Name

GDC Number

Telephone Number

Clinic Name

Clinic Address

City

Postal / Zip Code

Patient Details

Name

Date of Birth

Patient Telephone Number

Patient Mobile Number

Address

City

Postal / Zip Code

Referral Reason

Radiographs (drag files here or)

Clinical Photos (drag files here or)

Any Further Information

Relevant Medical and Dental History

By using this form I consent to my personal data being collected and stored for the purpose of marketing communications.

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Monday	10am - 6pm
Tuesday	9am - 5pm
Wednesday	9am - 5pm
Thursday	9am - 5pm
Friday	9am - 2pm
Friday	2pm - 5pm enquiries only
Saturday	By Appointment Only
Sunday	Closed