Junction Dental, the perfect stop

Endodontic Patient Referral Form

Endodontic Patient Referral Form

Welcome to Our Specialist Endodontic Practice We are dedicated to providing expert care for your patients, using advanced techniques and a patient-centred approach.

Junction Dental Watford

Referring Dentist Information

Patient Details

Reason for Referral

Please tick all that apply

Reason for Referral

Tooth/Area of Concern

Clinical Symptoms

Radiographs and Additional Information

Radiographs and Additional Information

Referring Dentist Notes

Preferred Contact for Updates

Preferred Contact Method

Receiving Practice Information

Process for Uploading X-Rays

We’ve made it easy for referring dentists to securely upload radiographs and other relevant files. Please follow the steps below:

  1. Prepare the Files
    • Ensure the radiographs are in a standard digital format (e.g., JPEG, PNG, or DICOM).
  2. Access Our Secure Upload Portal
    • Visit our Upload Portal.
    • Log in with your credentials or create an account if it’s your first visit.
  3. Upload the Files
    • Select the patient’s record or create a new entry.
    • Click the "Upload Files" button and attach the radiographs and any other relevant documents.
  4. Confirmation
    • Once uploaded, you’ll receive a confirmation email.
    • Our team will review the files and contact you if additional information is required.
  5. Need Assistance?
    • If you experience any issues, please contact our office directly at 01923 551222 or email us at info@junctiondental.co.uk.