REFERRALS

If you wish to send a postal referral form,
please download our form HERE.

West Street Dental Practice is welcoming patient referral from West Wales. We are specialised in the dental treatment of nervous patients. If you think that your patients are displaying signs of distress or anxiety whilst undergoing routine dental treatment, please let us know, so we may inform them of our sedation techniques.

The referral protocol is described below:

For E-Referrals the following information is required:

• Complete patient details and up to date contact numbers
• Relevant X-rays and full medical history
• Dental charting and a plan of required treatment
• Patient referral form

When requesting a treatment for one of your patients, please ensure that you complete the E-Referral form or download the PDF format (HERE) to enable us to carry out the dental treatment required.

If you need to speak with any of our support team or have any queries,
telephone us on : 01348873370 or 07377376699 or email : weststreetdental@yahoo.co.uk

At the WSDP we look after your patients as we would expect to be looked after ourselves.

Yours sincerely, Mr Adrian Chiriac (Pg Cert Sed) & sedation team

*   Mandatory required field

Referee Details

Dentist Name : Practice Name: * Your Email : Practice Phone :

Street Address: Address line 2: Town/City: County: PostCode:

Patient Details

Title: Patient First Name: Patient Last Name:

Street Address: Address line 2: Town/City: County: Post Code:

Telephone No: * Patient Email:

Patient Medical Conditions

Cardiac Problems

Rheumatic Fever

Respiratory

Diabetes

Epilepsy

Bleeding/Clotting

Sickle Cell Status

Allergies

Relevant information

Treatment required under sedation

Upload X-Ray/File

Please email any relevant images HERE Any difficulty using the link above? copy and paste referrals@weststreetdental.wales into your email of choice to send us any relevant files