If you wish to refer a patient to us for treatment you can do so in a number of ways. You can write, email, telephone or fill in the form below and request a referral pack.

Any additional information that you can provide us with will help make the referral as hassle-free and cost effective for the patient.

We will thoroughly discuss all treatment options and the costs of each with the patient and written copies will always be provided each time, so there is no confusion.

Patients will always be encouraged to return to your for further appointments (except during course of treatment).

If you are referring a patient, please click here to download our referral form or fill out the form below.

Any questions, use the get in touch button.

Patient details

Other information

NHS Orthodontics

Available to under 18s with at least ONE of the following ticked and good oral hygiene:

Private Orthodontics

Available to adults or under 18s who do not meet ANY NHS criteria.

Tick as many as required.

NHS Oral Surgery

Impacted third molar within NICE Guidelines :

Private Endodontics

Private Oral Surgery & Implants

Key NHS Checklist

Please tick all of the following before making an NHS referral:

Dentist details

*Referral services at Docklands Dental Referral Centre maybe provided by self employed dentists, specialists or external organisations

COPYRIGHT ALIGN & SMILE 2019 | GDC | Complaints Procedure | Privacy Notice | Last Updated: June 2024
Align and Smile Limited is a private limited company registered in England, registered number 07852159.
Our registered office is Unit 6 New Providence Wharf, Blackwall Way, London, E14 9PA.
Docklands Dental Referral Centre is the trading name of Dr Sabena Bhuiyan.