Please include any relevant file attachment such as radiographs, clinical notes or photographs. We accept the following files: JPG, PNG, DOC, DOCX, PDF.
This will act as the practitioner’s electronic signature: I hereby authorize The Dental Practice to carry out hygiene treatment on my behalf.
I have explained the need for referral to a hygienist and obtained my patient’s consent for the treatment to be carried out. I ACCEPT FULL RESPONSIBILITY FOR THE PATIENT’S PERIODONTAL CARE AND RESOLVE THE TREATING HYGIENIST/S FROM ANY LIABILITY.
I accept that the hygienist cannot and would not be expected to make a diagnosis beyond their scope of practice.
I’d like to be informed of exclusive offers and other practice information YES
You can phone us on 01273 452947.
Get in touch by calling us or by emailing us.
Get in touch by calling us or by emailing us today.
Please feel free to call us on 01273 452947, or complete the form below and one of our team will be in touch.
The Dental Practice 6 Southdown Road Shoreham-by-Sea West Sussex BN43 5AN
[email protected] 01273 452947