Endodontic Referral

Refer a patient

Please use the form below to refer a patient for endodontic assessment only or click here to download a printable version. For all other cases use the Prosthodontic referral page. Alternatively, please contact us to discuss your case.

"*" indicates required fields

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Patient Address*
MM slash DD slash YYYY

Relevant Clinical Information

Reason for referral
Please select clinician
Additional information
Drop files here or
Accepted file types: jpeg, jpg, gif, giff, png, Max. file size: 3 MB, Max. files: 5.
    Upload radiographs and images of the case in the following formats jpeg, jpg, gif, giff, png Up to 5 images allowed, max size 3MB per image
    No requirement for post or core?
    (Composite core placed as standard)1
    Tooth requires post-space preparation<sup>2</sup>

    Explanatory Notes:

    1. It may be necessary to remove the core to allow direct assessment of the underlying tooth structure. Please indicate if you would NOT like the coronal structure to be stabilized as part of treatment.
    2. A composite resin core will be used as standard. Please select if you would like the tooth to be prepared with a post space on completion of treatment. Parapost system used unless otherwise specified.

    Prosthodontic Referral

    Refer Now

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