Dentist referrals

At Straight Smiles, we love working with our fellow dental professionals to improve our patients’ smiles. If you would like to refer a patient to us for orthodontic treatment, please fill out the form below.

We will email you a copy of the completed information for your records – and keep you informed about any treatment plans for your patients.

Dentist's Details

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Patient Details

Send Us Your Photos

For any photos, xrays or additional information you wish to submit alongside this referral, please upload here. Accepted file types: jpg, gif, png, pdf (up to 5 files only; max file size 10MB)

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