cosmetic dentists


We truly value your trust in us, and trusting us with the care of your patient.

That is why we have created our referral form:

  1. We will acknowledge your referral and contact your patient to set an appointment.
  2. We will keep you informed of progress throughout the referral process
  3. We will provide you and your patient with a detailed treatment plan and estimate of fees
  4. We will involve you in the treatment planning if you wish
  5. We will only carry out treatment for which your patient has been referred for.
  6. We will always return your patient to your care once we have completed their treatment
  7. We will support you should you require any advice or assistance after we return your patient to your care
  8. We will invite you to our Study Club meetings and events


Check our testimonials and pricing to get an in-depth understanding of referral process

referral form

We would be delighted to assist in the care of your patient and we are happy to accept referrals for:

Orthodontics: Adults and children Fixed, removable and aligners, Early intervention orthodontics, Invisalign First, Complex orthodontic situations

Implant dentistry: Placement and/or restoration of dental implants, Implant-retained dentures, All-on X treatments

Cosmetic Dentistry: Aesthetic anterior restorations, Smile Makeovers, Challenging Aesthetic situations

Complex Restorative dentistry: Tooth wear, Restoration of the failing dentition, Partial or full rehabilitations, Management of occlusion

Oral Surgery: Bone, soft tissue & sinus grafting , Wisdom teeth and impacted teeth removal, Hard and soft tissue surgery

Facial Surgery and Aesthetics: Complex facial aesthetics, minor facial surgical procedures

"*" indicates required fields

Referring Practitioner

Practice Address*

Patient Details

DD slash MM slash YYYY
Patient Address*

Parents/Guardian details

(For children under 16 years of age)

Medical History

Oral Health

Teeth to treat

Click to mark teeth to treat

Upper teeth
Lower Teeth
Level of Urgency

Referral Details

Referral Treatment*
I would like to be present during the consultation/treatment
I would like you to contact me to discuss the case
I would like you to treat as you see necessary and let me know of your plan for this case
I would like to restore this case (implant placement only)
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    Ask a Question

    Get in touch with the Canon House Team to find out more about any aspect of cosmetic or restorative treatment.