Sussex Implant Centre & Advanced Dentistry
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01273 698045
Sussex Implant Centre & Advanced Dentistry
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Referral Form
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Referring Practitioner *
Patient Details *
Referral Details *
Implantology
Consultation
Placement Only
Placement & Restoration
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Endodontics
Incisor/Premolar
Molar
Re-RCT
Root-End Surgery
Other
Oral Surgery
Consultation
Tooth Removal / Root Removal
Surgical Tooth Removal
Socket Preservation
Wisdom Tooth Removal
CBCT Scan
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OPG
With Report
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Patient would like to have IV sedation
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