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Dental Patient Referrals Form

REFERRAL FORM

About You

About Your Patient

What tooth needs treating?

Photos and/or radiographs

 If you want to send photos and/or radiographs to support your referral please send them to info@perfectteethdental.co.uk using WeTransfer.
Your personal information

About You

About Your Patient

About your referral

What tooth needs treating?

Dental Implants
Extraction
Laser Dentistry
Implants
TMJ and Clenching
Invisalign
Facial Pain
32Co Teeth Aligners
Snoring Appliances
Smile Makeover
Root Canal Treatment
Extractions & Wisdom Tooth Removal

Photos and/or radiographs

If you want to send photos and/or radiographs to support your referral please send them to info@perfectteethdental.co.uk using WeTransfer.

Your personal information

I consent to my personal data being collected and stored as per the Privacy Policy.
I consent to my personal data being collected and stored for the purpose of marketing communications.

How did you hear about us?

Dr. Poonam Julka

General Dentist

Poonam has 12 years experience as a General Dentist. She did her Overseas Registration Exam in 2012. Since her graduation she has completed courses in Restorative and Cosmetic Dentistry and is currently doing a PG Diploma in Endodontics.

She loves her work and hence regularly attends courses in  Dentistry to keep her  updated  in the profession.

As a part of her Continual Professional Development, she  has  completed a number of Consultant led courses in Restorative Dentistry from Eastman Dental Hospital . This has equipped her with the skills to provide a high level of Dental treatments.

When she is not busy in the clinic, she likes to spend time with her family and enjoys walking and reading books.