Find Us

872 The Crescent, Colchester Business Park, Colchester, Essex CO4 9YQ
Talk to us 01206 756210


You can refer private patients to us by filling in the form below. This will send an email directly to our practice. One of our team will then get in contact with you as soon as possible.

Please note: that this form cannot be used for NHS referrals. These need to be made via post or NHS secure mail using a hand written pro forma.

If you are a patient and looking to refer yourself then please click here to use the self referral form

Fields marked with * are Mandatory
Patient details
  • Email Address:*
  • Name:*
  • Tel No:*
  • D.O.B.:
  • Address:
  • Postcode:
Dentist details
  • Dentists Name:
  • Dentists address:
Additional comments
  • Your comments: