Welcome to the Brilliant Dental Care referrals page.  

Book from your most popular referral services 

• Dental Implants

  Refer a Dental Implant Patient 

  Referring Dentist Details

  Dentist name

  Practice name

  Practice address

  Practice post code

  Practice telephone number

  Practice email

  Patient Details

  Patient name

  Date of birth

  Patient address

  Patient post code

  Patient telephone number

  Patient email

  Patient Medical History

  Referral information

  Reason for referral

  —Please choose an option—CBCT – With reportCBCT – Without reportOPTOrthodonticImplantologyOral SurgeryCosmetic DentistryProsthodonticsPeriodonticsEndodonticsTMJFacial Aesthetics

  Will you be completing the restoration on the implant

  YesNo

  Teeth to be treated

  Dentist notes

  Upload enclosures/xrays

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  del

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  Add file
• TMJ
• Facial Aesthetics

Admin Fee

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To see a full list of all our referral services please see our main referrals page or you can book a referral now online or download our printable form

Please feel free to browse our website or contact any member of our team for information and guidance.