Submit your referral quickly and safely via our encrypted online referral form below. - Please note we are unable to accept oral surgery referrals via this form.
Download and complete our PDF referral form, then post it to:
71 Dental
71 Towngate
Leyland
PR25 2LR
If you'd like to talk through a potential referral, please don’t hesitate to get in touch.
Jade is happy to help and can arrange any further discussions with the appropriate clinician.
Once we receive a completed form, we will contact the patient to arrange an appointment. If the referral is from a dentist, we will also liaise with the referring practice.
If you’re referring yourself, we will only contact your dentist if you give us permission to do so.
