fbpx
24 Furness Quay, Salford M50 3XZ
Reception: 01614138330 / Courses: 01618335

Referrals For Prof Ucer

 Referrals for Prof Ucer

If you would like to be referred to Prof Ucer’s private practice, please contact the Manchester Dental Implant Clinic directly on: 0161 237 1842 or mel@mdic.co or fill out the referral form below.
Referral Form

Date Of Birth

Telephone Number:

Mobile Number:

Email Address:

Address:

Referring Practitioner Section Only
Name:
Practice Address:
Practice Telephone Number
Practice Email:

Proposed Treatment Details

Teeth that require treatment

Please provide further details: (e.g.
when tooth was XLA, Root Fracture
etc) ………

The patient is aware that the treatment will
be carried out by supervised clinicians
training in Implant Dentistry:

Date:
Sent In By:

Send Form