Oxford Dental Centre

162 Banbury Road, Summertown, Oxford OX2 7BT

01865 515 806

Patient Referral Form


Dear colleague, we can be referred for treatments Under Sedation, Implant Treatment and Oral Surgical Procedures (Extractions). Patient referrals can be made to our clinical team by completing the online referral form or contacting the practice directly. If you have any relevant documents / xrays etc, you can email them to us separately at info@oxforddentalcentre.co.uk or post them to us.


We will inform you of the recommended treatment after the first consultation with your patient, and will keep you fully informed of treatment progress at all times.


Referring Dentist / Practice Name

Referring Dentist Telephone

Referring Dentist Email

Referring Dentist Address

Patient Name

Patient address and Telephone

Medical History of Patient

Treatment Required