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39 Newnham Road • Cambridge • CB3 9EY

Referral

Referring Dentist

Patient consent has been received for this referral

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Patient Details

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Is this referral urgent?
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Relevant Medical History

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Referral Details

  

Other Treatment Requested

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Please carry out any treatment necassary prior to implant placement
Please liase with referring practice for restorative treatment prior to implant placement