01392 873899 384 Topsham Road, Exeter, EX2 6HE

Orthodontic Referral Form

If you would like to refer a patient to our practice, please complete the form below, or click here to download and print a paper copy.

Referrer's Details

Patient Details

Reason for Referral

Medical History / Additional dental information

I have explained to the patient that this is a referral for a private consultation*

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*By clicking ‘send’ you are consenting to us replying, and storing your details. (see our privacy policy).

Content

Contact Form

Please complete the form below and we will get back to you as soon as possible.

Coronavirus (Covid-19) Notice

Dear Patients

Dee Shapland Dental will be reopening on Monday 15 June.

Thank you for your patience whilst we finalise the huge amount of compliance and training in order to provide you with safe and effective care.

We will be contacting our patients who have had a dental emergency or problems initially and we ask that if you have a dental emergency in the meantime please call: 07778059518 to speak to Nick or Anastasios who will endeavour to help you.

Please click on the link below to read our latest blogs describing our return to practice and your ‘new dental journey’. If you visit our Facebook page, Anastasios has made a short video to help you plan for your next visit.

We look forward to seeing you soon.

Nick, Anastasios & All the Dee Shapland Dental team

 

Phased Re-opening Plan

Messages from Nick & Anastasios and ‘helpful tips’ & guidance can be found on our ‘Facebook’ page and ‘Blog’ page of our website.