COVID-19 - Due to the constantly changing situation please view the ‘Patient Updates’ page for all current information. MEDICAL HISTORY FORM


At The London Centre for Prosthodontics we welcome referrals for all aspects of implant, restorative and aesthetic dentistry. We are delighted to work closely with referring practitioners, offering our help and expertise for all aspects of patient care from the treatment planning process through to the execution of treatment. We are happy to discuss and treatment plan cases for dentists wishing to carry out the work themselves. Alternatively and for selective cases, we are happy to carry out a specific stage of the treatment if the dentist wishes to carry out the remaining treatment themselves.

If you wish to refer your patient to The London Centre for Prosthodontics, please complete and submit the adjacent referral form. Alternatively, you can write to us or e-mail us at Please feel free to send any additional information which you feel might be helpful such as radiographs. We will contact the patient to arrange an appointment and keep you informed of their progress at every stage.

We provide only the highest level of care for all our patients. Our commitment to excellence will ensure that your patient will receive dental care of the most superior calibre.

Thank you for your referral.

Referral Form

Referring Dentist Contact Details

Patient Information

Referral details

Please Tick The Captcha Box Below Before Submitting - Thank You!

required fields marked *
Powered by dB Masters Multimedia FormM@iler

Please note - this contact form should only be used for transferring information of a non-sensitive nature. If you wish to provide us with medical information or other potentially sensitive data, please contact us by telephone on 020 7637 4518 and we will advise.