New Patient Referral - College of Medicine & Dentistry

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New Patient Referral

New Patient Referral

New Patient Referral

Please complete the form below. You must be 16 or over to register.

Full Name

Male Female

Provide a contact email

Do you have a dentist?

Yes No

What treatment are you interested in?

Agree to Policy Agreement

Yes

Link to Policy Agreement

Referral Team
Dental Hospital
College of Medicine and Dentistry
32-34 Colmore Circus
Birmingham
B4 6BN

Email: Clinic@comd.org.uk
Telephone: 0121 345 9833

Telephone

+44 (0)121 345 9833

E-mail

clinic@comd.org.uk

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