You can make a referral in 3 ways:

1) Via Email:

– Click here to download our Referral Form

– Fill out all the required fields marked (*)

– Attach the Referral Form with any supporting xrays/images/charts and send to info@kdentalstudios.co.uk

2) Via Post:

– Click here to download our Referral Form

– Fill out all the required fields marked (*)

– Please send your Referral Form with any supporting xrays/images/charts to: 116 Great Portland Street, London, W1W 6PJ

3) Online Form: (compatible only with computer users)

– Please fill out the form below and click on send ensuring that you have filled out all

the required fields marked with (*)

    Please tick the appropriate referral: *


    Mr Cesar Muñoz-Villena
    Practice Limited to Endodontics
    DDS MSc (Endodontics)
    GDC: 208309


    Ms Dimitra E Tsarouchi
    Specialist in Periodontics
    BDS(Lond), MClinDent (UCL),
    CertPerio (EFP), MRD RCS (Eng)

    GDC: 103982


    Ms Deborah Bomfim
    Consultant & Specialist in Restorative Dentistry,
    Clinical Lecturer in Restorative Dentistry
    BDS, MSc (UCL), MJDF RCS (Eng),
    FDS (Rest Dent) RCS (Eng)

    GDC:103979


    Ms Sara Stephens
    Specialist & Consultant Orthodontist
    BDS, MJDF RCS (Eng), MClinDent Orth (Distinction),
    MOrth RCS (Eng), FDS (Orth) RCS (Eng)

    GDC:103298


    Ms Ayse Nazli Spencer
    Specialist Oral Surgeon
    BDS (Lond) MJDF RCS(Eng),
    GCAP M.Oral Surg

    GDC:104084


    Ms Irene Kaimakamis
    Principal Dentist, Special Interest in Fixed Prosthodontics,
    Honorary Speciality Dentist King’s College Dental Hospital
    BDS, MJDF RCS (Eng),
    MSc (UCL)

    GDC:104215


    Ms Meranda Gomez-Adams
    Dental Hygienist Therapist
    DipDH DipDT RCS (Eng),
    BSc (Hons)

    GDC: 258289

    Patient Details: *

    Title: Miss/Mrs/Mr/Dr/Other:

    Surname:

    Forename(s):

    Date of Birth:

    Address:

    Postcode:

    Tel/Mobile:

    Email:

    Reason for Referral: *

    Please give as much detail as possible and include any treatment already carried out:

    For Endodontic Referral Only:

    Right
    Left

    8765432112345678


    8765432112345678

    Is the Patient in pain?
    Final restoration to provided by Dr Munoz?
    If yes, would you like:

    Enclosures (Please tick):



    (Please note that enclosing good quality radiographs will speed up the referral process)

    Upload here:


    (Maximum upload filesize: 5Mb)

    Relevant Medical History: *

    Practice Details: *

    Referring Practitioner:

    Referring Practice:

    Practice Address:

    Post Code:

    Telephone:

    Email: