For Dentists

 

Referrals may be made with the online referral form below. Alternatively please see Dr McHugh’s contact details

 

Patient Name*

Patient Address

Date of Birth

Telephone Number*

Mobile Number*

Medical Insurer (If Applicable)

Treatment

Treatment Required

"Most fees are tax deductible at 20%. For a price guide, please contact us here."

Referring Dentist / Doctor

Name*

Address

Phone Number

Fax Number

Email Address*

Document Upload

Radiograph Upload