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

Upload X-rays / OPG

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Accepted file types: jpg, gif, png, pdf.
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