Referring Professionals

Please fill in the referral form below.

Dear colleagues,

Optimal quality of dental care is the goal of every clinician. Achieving this goal requires a successful, honest and constructive collaboration between the referral dentist and the endodontist.

In our practice we undertake exclusively endodontic cases - microsurgical and non-surgical - always in direct contact with the referral dentist.

After the root canal treatment, the patient returns back to the referral dentist for the completion of the treatment plan. Also, a follow-up examination is performed in order to evaluate the therapeutic result.

Below you can see and fill in the patient's referral form. In case you wish to receive a hard copy booklet of referral forms, you can contact us at info@allaboutendo.gr.

REFERRING PATIENT FORM

Fields with an * are mandatory.
This field is mandatory!
This field is mandatory!
This field is mandatory!
This field is mandatory!

Upper Right Quadrant

Upper Left Quadrant

Lower Right Quadrant

Lower Left Quadrant

This tooth/teeth require(s) root canal therapy:
This Tooth/Teeth Require(s) Retreatment:
Existing Crown/Bridge
Crown will be Replaced
This field is mandatory!
Please fill in all fields with an asterisk.
Form was sent successfully. Soon we will get in contact with you.

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