Refer yourself

We’re happy to receive self referrals for all our dental services including gum disease treatment (periodontics) with our Specialist Periodontist Dr Joel Thomas, teeth straightening (orthodontics) with our Consultant Specialist Orthodontist Mr Scott Deacondental implants with our Principal Dr Jonathan Cochrane, oral surgery and/or sedation with our Principal Dr Jonathan Cochrane and/or Dr Kathryn French, endodontics with Dr Umut Gokay EmirTMD and dental sleep medicine with Dr Devin Vaghela.

We also help extremely nervous patients who require sedation in order to access dental treatment, and we’re always happy to take patients for any kind of routine dental treatment.

Please complete the online form below.

Alternatively, if you would like to download a printable version of the referral form, please click here. Once completed, please either email it to us at [email protected] or post it to us at The Bristol Dental Practice, 1 Queen Square, Bristol, BS1 4JQ. Thank you.

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    I'm mainly concerned about (tick as many as you like)
    I am self-conscious about my teeth when I smileI have gaps between my teethThe colour of my teethBad breathMy dentures are uncomfortable, they look like denturesSome of my teeth are dark, chipped or misshapenI grind my teeth at nightI play a contact sportI am worried about the cost of treatmentMy gums bleed when I brush themMy teeth are not as bright as I would like them to beI have unsightly silver fillings

    On a scale of 1-10 please rate your smile*

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