Dentist referrals

Thank you for looking to refer your patient to us at Dublin Orthodontist.

Below we have provided a simple form to refer your patient for private orthodontic or dental treatment. We look forward to working closely with you to help protect and transform your patient’s smile.

Referring dentist details

Name

Practice address

Phone

Patient Details

Name

Date of Birth

Phone

Parent/Guardian's Name (if patient is under 18)

Address

Reason for referral

Referral

Find Us

Dublin Orthodontist is conveniently located just 15 minutes from Dublin City Centre and 5 minutes from the M50 Ballymun exit. We are in the College Gate Clinic just across from DCU college. Now accepting new patients from Glasnevin, Finglas, Drumcondra, Santry, Ballymun, and all surrounding areas.