Referral Form

ChatGPT Image Jun 12 2025 05 17 31 PM

Referral Form

To refer a patient, Complete our secure online referral form  and submit.  Click the button To fill the form

To refer a patient, simply complete and submit the appropriate referral form. Please ensure all relevant clinical information is included, and don’t forget to attach any x-rays, if applicable.

Referral Options:

  • Online Referral:
    Complete our secure online referral form with the patient’s details and treatment requirements.
  • Email Referral:
    Send the patient’s details and treatment needs to us directly at:
    info@frederickstreetdental.co.uk
  • Phone Referral:
    Call us on 0131 629 1158 to discuss the patient’s details and treatment requirements with a member of our referral team.
  • Postal Referral:
    Post the patient’s details and treatment needs to:
    57 Frederick Street, Edinburgh, EH2 1LH

Step 1 - PATIENT DETAILS

Step 2- REFERRING DENTIST'S DETAILS

Step 3 -REFERRAL DETAILS

Click or drag files to this area to upload. You can upload up to 3 files.