top of page
Phone:
020 8881 0495
Mail:
info@happysmiles.dental
Address:
1
29-131 High Rd Wood Green
Home
Our Team
Treatment
Dental Implants
Invisalign
Emergency
Cosmetic Dentistry
Periodontal Treatment
Endodontic Treatment
Fees
Referral for Dentists
Contact Us
WHATSAPP US
Referral for Dentist
Happy
Smiles
Dentist
Referral for Dentist
Treatment Required
Implants
Oral Surgery
Invisalign
Root Canal
CBCT
OPG
Other
Please fill in the full details of the treatment requested / Justification for the radiograph / Area of interest (mandatory)
18
17
16
15
14
13
12
11
21
22
23
24
25
26
27
28
Lower
48
47
46
45
44
43
42
41
31
32
33
34
35
36
37
38
Patient Details
Short answer
Short answer
D.O.B.
Month
Country/Region
Address
City
Zip / Postal code
Is there a possibility of pregnancy for
OPG/CBCT? (Mandatory)
Single choice
Yes
No
Long answer
Referring Dentist
First name
Number
Last name
Country/Region
Address
City
Zip / Postal code
Phone
Please state what has been enclosed
X-Rays
Medical History Sheet
Casts
Are they bringing own Radiographic template?
Other
Upload any Radiographs, pictures or documents here
File upload
Upload File
Submit
bottom of page
