Self Referral

If you are a private patient you can be referred by your dentist or you can self refer yourself for a consultation. Please call us on 020 8445 1199 or email us with your full name, date of birth and contact telephone number and a brief description of treatment required along with any relevant xrays.

Self Referral Request Form

Patient Details:

    Please could you see me about:-

    Oral Surgery e.g Extractions, Apicetomy
    Endodontics (Root Canal)
    Dental Implants
    Periodontics (Gum Problems)


    I am unsure about what treatment I require

    Please describe the problems you are having:

    Relevant Medical History:

    Thank you, we will be in touch within 24hours of your email enquiry (Weekdays only) If you have an xray relating to this referral please send seperately to with your name and D.O.B.

    Or print off the PDF form here and either fax it or post it to us.PDF

    What happens next?

    After an initial consultation and preliminary examination at London Day Surgery Centre, one of our resident surgeons will discuss your options and offer you advice on the best treatments for you. We will ensure you know exactly what to expect and how to prepare yourself for the procedure. Your treatment will then be arranged and a complete estimate of costs prepared. After your treatment, you may be directed to our comfortable recovery area, where you can relax until you feel completely ready to return home or back to work. Our staff will monitor your progress throughout your visit and will provide complete follow-up consultation as necessary.

    If you have any queries please call us today on 020 8445 1199