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Knightshill Dental Practice

132 Knights Hill, West Norwood, London SE27 0SR


 020 86704666


Patient Referral Form


Dear colleagues, private referrals can be made to our clinical team by completing the online referral form or contacting the practice directly. If you have any relevant documents / xrays etc, you can email them to us separately at or post them to us.



We will inform you of the recommended treatment after the first consultation with your patient and will keep you fully informed of treatment progress at all times.




Referring Dentist / Practice Name

Referring Dentist Telephone

Referring Dentist Email

Referring Dentist Address

Patient Name

Patient address and Telephone

Medical History of Patient

Treatment Required