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Mon : 9.00 - 17.30

Tue: 8.15 - 17.30

Wed - Thu: 9 - 17.15

Fri: 8.00 - 14.00

2 Harboro Way, Sale, M33 6QX

EMERGENCY DENTIST

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DENTIST REFERRALS

At Ash Villa Dental Practice, we welcome referrals from dentists across Sale for a variety of treatments listed on the form. If you’re already a patient, you can book online

Patient Details

First Name

Email

Last Name

Phone Number

Patient Date of Birth

Street Address

City

Street Address Line 2

Postal / Zip code

Type of referral

I am referring for (Required)

Implant Case

Invisalign

Oral Surgery

Restorative

This case

Is Urgent

Non Urgent

Requires IV Sedation

Implant Referral (Required)

Opinion Only

Bone Grafting / Sinus Elevation / Soft Tissue Correction

Surgical Placement / Uncovering

Full Case

Oral Surgery (Required)

Retained Roots

Apicectomy

Wisdom Teeth

Other

Other

Teeth to treat

Radiograph or Image

Upload File

Upload supported file (Max 15MB)

Further Details

Patient Complaint / Reason for Referral(Required)

Relevant Medical History

Dentist Details

Dentist First Name (Required)

Dentist Email (Required)

Dentist Last Name (Required)

GDC Number (Required)

Thanks for submitting!

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TO ARRANGE A REFERRAL, JUST ASK ASH VILLA DENTAL PRACTICE

Speak to our dentists in Sale about getting signed up

reception@ashvilladental.com

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reception@ashvilladental.com

Ash Villa Dental Practice Ltd registered as a limited company in England and Wales under company no: 07737619. Registered address: 2 Harboro Way, Sale, Cheshire, M33 6QX

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