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Referral into the Service

For professionals wanting to refer into our service, please use the following referral forms depending on your reasons for referring:

For every referral please compete the appropriate form

Special Care Clinics (form)

f your patients suffers from any of the following conditions, you will need to complete a supplementary form, listed below:

For Nervous and Anxious Patients use this the Pain and Anxiety form. However, if you are a Dentist, please use this Paint and Anxiety Dental form instead.

For Mental Health Patients please also complete the mental health form.

Please note we accept electronic referrals by colleagues who have email accounts, because these are secure and allow confidential patient information data to be sent securely. If you are using an alternative email account, then please post us the completed referral forms in the post to the following address:

Referrals Coordinator
Community Dental Service
Firth Park Clinic
North Quadrant
S5 6NU

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