The Dental Implant Clinic The Dental Implant Clinic The Dental Implant Clinic

Use the form below to send an Online Enquiry to The Dental Implant Clinic. We will endeavour to respond as quickly as possible, usually within two business days. All fields are required for a successful submission. Alternatively, you can email us at info@thedentalimplantclinic.com

Practitioner's Details

Patient's Details

Request

URGENCY

Urgent

Non-Urgent

BRIEF DESCRIPTION OF REQUEST

Implants - please tick

   

  8     7    6    5    4     3    2    1         1    2     3    4    5     6    7    8

   

Extractions - please tick

   

  8     7    6    5    4     3    2    1         1    2     3    4    5     6    7    8

   

Periodontal Disease

Localised

Generalised

Regeneration

Peri-implantitis

Gingival recession

Crown Lengthening

Gummy Smile

Other (please specify):

Endodontics - please tick

   

  8     7    6    5    4     3    2    1         1    2     3    4    5     6    7    8

   

Any Other Requirements or Complications

We will try to repond to all referrals as soon as possible, and may need to request further information or radiographs from you.

ITI Member University of Bristol MSc in Implantology Teaching CentreBACD Member ADI Member Straumann Platinum Approved

Dr. Jonathan Schofield is a member of the ITI and the ADI. Dr. Chris Lambert-Rose is a member of the BACD. We are a teaching centre for the Bristol University MSc in Dental Implantology.

The Dental Implant Clinic, 24 Newbridge Road, Bath, BA1 3JZ | 01225 448400 | info@thedentalimplantclinic.com

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