For Dentists

 

Referrals may be made with the online referral form below. Alternatively please see Dr McHugh’s contact details

 

    Patient Name*

    Patient Address

    Date of Birth

    Telephone Number*

    Mobile Number*

    Medical Insurer (If Applicable)

    Treatment

    Treatment Required

    "Most fees are tax deductible at 20%. For a price guide, please contact us here."

    Referring Dentist / Doctor

    Name*

    Address

    Phone Number

    Fax Number

    Email Address*

    Document Upload

    Radiograph Upload