We aim to make the referral process as easy and efficient as possible. You can refer patients online using the form below or, if you haven't already, download our Referral App to your desktop to save you time. The Referral App will bring you to this form in just one click and with your details pre-populated, also giving you easy access to all the resources in Dentist Connect (you won't need to remember your username or password in future).

Log In to Dentist Connect for Faster Referral

Patient details


Clinical details

Please click a tooth number below and enter the details for each tooth or type your own referral reason in the box below.

Restorative requirements
X-ray Attachment
Must be a JPG, GIF, PNG, TIFF, PDF, DOC or DOCX file no larger than 3MB with only - and _ characters in file names.

Drop multiple files at once or

Dentist / Practitioner Details

If you are requesting a copy of this referral, please be mindful of patient confidentiality when confirming your preferred email address above.

Before you submit

Your privacy is important to us. The Endodontic Group collects and deals with your information in accordance with our Privacy Policy, Disclaimer and Charter of Patient Rights.