Refer a patient

Please note Dr Chesterman is only currently accepting referrals for periodontal and dental implant treatments. You will receive a technical report following the consultation.

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Thank you for your referral.

Referring Dentist Details

Referring Dentist Name

Referring Practice

Practice Address

Practice Email

Practice Telephone

Patient Details

Patient Name

Patient date of birth

Patient Address

Phone Number

Mobile Number

Referral Details

Please provide a summary of the reason for referral:

Please state if you are requesting treatment or advice only. (required)

Treatment Advice/opinion only

Please state which practice you are referring to(required)

Church View Dental Care, Crossgates, Leeds, LS15 8BB. Honesty at the Oaks, 192 Swan Avenue, Eldwick, Bingley, BD16 3PA.

Please confirm this referral is for dental implants and/or periodontal treatment

Please confirm that the patient is aware that advanced treatment may not be appropriate due to overall dental heath status and clinical scenario

Please confirm you have informed the patient of the referral

Please note if you wish to attach clinical photographs or radiographs please email these to restorativedentist@outlook.com and include name of patient and referring practice.

Dr James Chesterman

Specialist Periodontist, Restorative and Implant Dentist