Referral form for New Park House Dental Centre / UKSedation

Please use this form for adult oral surgery referrals with or without IV Sedation.

We want to make the referral system as simple as possible, once you have submitted the form we will arrange a suitable time to see the patient.

Please don’t hesitate to contact us if you’ve got any questions.

Patient Details

IV sedation required?

Maximum file size: 268.44MB

Referrer Details