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: *


    Dentist with an Interest in Facial Aesthetics
    BSc (Hons) BDS (Lpool)
    GDC: 70976


    Dentist with an Interest in Facial Aesthetics
    BDS (Lond)
    GDC: 228846

    Patient Details: *

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

    Surname:

    Forename(s):

    Date of Birth:

    Address:

    Postcode:

    Tel/Mobile:

    Email:

    Reason for Referral: *

    Previous History of Facial Aesthetics Treatment(s):*

    Please give as much detail as possible:

    Treatment(s) of Interest: (please tick one or more)

    BOTULINUM TOXIN

    DERMAL FILLERS

    Enclosures (Please tick):

    Upload here:


    (Maximum upload filesize: 5Mb)

    Relevant Medical History: *

    Practice Details: *

    Referring Practitioner:

    Referring Practice:

    Practice Address:

    Post Code:

    Telephone:

    Email: