Book your consultation
location icon email icon phone icon
The Specialist Orthodontic Referral Centre
reception@david-gale.co.uk 01329 284 419

Private orthodontic referrals

Specialist orthodontist David Gale and his experienced team welcome referrals from professional dentists on behalf of their patients, and private referrals from patients themselves.

Please fill in the form below or contact us for further information.

introduction-image
  • Referring Dentist Details
  • Patient Details
  • Orthodontic problems requiring immediate help
  • Funding
  • Previous Radiographs

    Radiation Protection Regulations - If a patient has had an OPG, cephalogram or other relevant radiographs in the last 12 months you are required to supply them with the referral letter. These will be scanned in and the originals returned to you immediately if required.

  • Relevant attachments

  • *By clicking ‘submit referral’ you are consenting to us replying, and storing your details. (see our privacy policy).

full-width-image
contact form image
Get in touch with us today

Let us help you with our specialised orthodontic care.
Our friendly and welcoming team are waiting to hear from you!

  • *By clicking ‘submit secure form’ you are consenting to us replying, and storing your details. (see our privacy policy).