top of page

I would like..

Menu

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

Oral Surgery Referral Form

We accept referrals for all aspects of oral surgery and oral medicine including but not limited to:

Wisdom tooth extraction (on site CBCT/OPG)
Tooth extractions
Soft tissue biopsies
Cyst removal
Dental Implants

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 if necessary - £65
Virtual consultation - free
Surgical extraction - From £200
Soft tissue biopsy - From £350
Other surgery - Price per case

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

bottom of page