Referral Form

Referral Form

In order to refer a potential patient to us, or become a patient with us please download the appropriate form, complete as thoroughly as possible and then return the referral/patient questionairre form to us electronically at referrals@DentalPB.co.uk by fax to 01483 728989 or via the post to:

The Dental Practice On Broadway
Private & Referral Dental Practice
6 The Broadway
Woking
Surrey GU21 5AP


As a patient, please click here to download a PDF copy of our patient medical history questionnaire form.

Should you have any queries then please call us during office hours on Tel: 01483 730808.