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Vitruvian Dental Studio, The Springs, Thorpe Park View, Leeds, LS15 8GH

Cosmetic Dentistry
Referral Form

We accept referrals for patients wanting cosmetic dental treatment such as composite bonding, veneers and full smile transformations.

If you have a case which you are unsure about please don't hesitate to send us a message.

Our prices are as follows:

Initial consultation - £65
TCO consultation - free
Composite Edge Bonding - £180/tooth
Composite Bonding - £300/tooth
Veneers - £650/tooth

Referrer Details

Dentist Name

GDC Number

Practice Name & Address

Telephone Number

Email Address

Patient Details

Patient Title

Patient Name

Patient Address

Date of Birth

Phone Number

Email Address

Relevant Medical History (Include conditions, medications, allergies)

Upload any radiographs or documents

Upload File

Case Details

Additional information (optional)

Thanks for sending your referral! We will be in touch soon

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