Online referral for dentists

You can either complete the online referral form below or fill in the pdf file and email it to us.

Please note: NHS referrals are only for patients aged 17 and under


We are happy to provide orthodontic consultations for your patients. Please refer your patients by using this online referral form. Please note that NHS referrals are only for patients aged 17 and under.

 

Field marked with * is required.

Dentist's details


Patient details

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BDA Good practice member

British Orthodontic Society

World Health Organization

American Association of Orthodontist

East Croydon

Orchard Orthodontics
114-118 Cherry Orchard Road
Croydon
Greater London
CR0 6BA

020 8649 7500

Directions & Opening times

Cobham

Orchard Orthodontics
12 Church St
Cobham
Surrey
KT11 3EG

020 8649 7500

Directions & Opening times

Brixton

Orchard Orthodontics
8 Brixton Hill,
Brixton,
London
SW2 1EG

020 3973 9335

Directions & Opening times