Referral Form - Dentist Suffolk

For all patient referrals, please fill out the referral form below.

Referring Dentist Details
Dentist Title:
Dentist Name:*
First Last
Old Dentist Name:
Dentist Email address:*
Dentist Telephone:*
Dentist Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Date:*
Patient Details
Title:
Name*
First Last
Old Name
Email address:*
Date of birth:*
Day
Month
Year
Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Telephone (daytime):
Telephone (evening):
Telephone (mobile):
Reason for referral:
Relevant medical history:
Type of referral*
- Multidisciplinary
- Periodontology
- Endodontics
- Restorative/Prosthodontics
- Orthodontic
- Minor Oral Surgery
- Pain management
- Facial Aesthetics
- Other
Upload Radiographs/Pictures
Drop files here or
Accepted file types: jpg, jpeg, png, gif, pdf, Max. file size: 256 MB.

Note to our referrers

It is our policy to limit referral activity to the referral itself and refer patients back for care to their general dental practitioner. We believe that this collaborative approach to care is in the patient’s best interest and forges a healthy partnership between you the referrer and our Specialists or Complex Care Providers and our mutual patients. Our Complex Care Providers are non-specialist surgeons with proven expertise in certain areas of dentistry. We also have specialists in Prosthodontics, Endodontics, Periodontics, Orthodontics and Minor Oral Surgery. Several of our practitioners also have a special interest in pain management by the use of low level laser therapy and facial aesthetic services.

If you ever have any queries about referral care please do not hesitate to e mail our practice manager and she would be pleased to assist you. Please e mail on :

[email protected]

Endodontics

Periodontics

Dental Implants

Orthodontics

TMJ & Facial Pain

Marty Gionis

2 years ago

Antwerp House was absolutely fantastic. I had a frenectomy on my tongue, and Raj and his team were clear and accomodating which made the whole process as stress-free as possible. It has produced excellent results and as a brass player and someone studying languages, it's changed my life - thank you!! I absolutely recommend this practice.

Imran H Uddin

Spoke to a lady over the phone called Ambea. She was very polite and resolved my query regarding pricing on your dental packages.

Joanne Bilton

We see Kerry for my sons braces, kerry is always so lovely, friendly and caring, had to be seen as emergency today and all though kerry was fully booked she found time to fit us in and sort the problem very promptly, amazing service, appreciate kerry and her nurse always fantastic and helpful

Hanna Sparks

Antwerp House Dentistry helped me straighten my teeth and I would highly recommend them to anyone looking to do the same! I used their Invisalign services, and was very pleased with the results as well as their customer service. When I initially sought Antwerp House Dentistry, I informed them that I only had a few months left in the UK before moving to Germany. They were incredibly accommodating and ensured I had all necessary aligners and equipment before moving. Additionally, they scheduled virtual or telephonic check-ins when possible, and when it was necessary to schedule an in-person check-up they were able to accommodate to days that worked for me. They made the process straightforward and easy, especially considering my unique circumstances. The results are exactly what I imagined, and I’m so pleased I went with Antwerp. Definitely recommend!

Charlie Atkinson

I've always been anxious about dental visits, but this practice has completely changed that for me. The team is so understanding and patient, ensuring I was comfortable every step of the way. My recent filling was done quickly and, to my surprise, completely pain-free! I’m so relieved to have found a dentist I can trust.

Elanoré Ward

I cannot praise Antwerp House Dentistry and Preeti Bose enough, 12 months ago I was petrified to attend a dentist and put it off for years. But after a few appointments with preeti over the past 8 months, my fear of attending the dentist has gone and my teeth are well on the way to being the best they ever have. Thank you so much! 😁

Ami

Shockingly incompetent and unorganised. My son had an orthodontist referral to Antwerp house in January 2023 whereby I was told he would be waiting 18 months to be seen. I called for an update in March 2024 only to be told the referral had been ‘lost’ (although they confirmed it was sent to them in January 2023) so another referral had to be made in April 2024. I was told it will be backdated to January 2023 as it was their error. I then called in October 2024, 18 months later, to be told it’s only valid from when it was resent to them as they can’t backdate referrals, even though it’s their fault? My son has to wait another 11 months on top of the 15 months he has already waited, for his braces. By this time, the likelihood of his bite being improved is minimal due to him being fifteen. Ridiculous. Don’t waste your time or money, there are plenty other dentists that won’t let you down.

Katie Tubbs-Murphy

I recently seen Roberta for a Hygienist appointment, she used new fancy airflow which was lovely! My teeth felt so clean afterwards. I have terribly sensitive teeth which I have struggled with in Hygienist appointments in the past, I did not experience any of this, this time as the water was warm. I have rebooked for 6 months time, I cant wait! Thank you Roberta!

James Gilbert

I've been to a few different dentists over the past 2 years and can honestly say Antwerp House is by far the best. Today I saw Roberta the hygienist and she is brilliant. Not only did she do a great job she also spent some time giving me great advice. It really halted my anxiety regarding my teeth. It was a little more expensive than the other places I've been but it is so worth it, trust me. Reception staff are lovely too.. overall a 10/10 dentist. I won't go anywhere else!

K K

Went 1-2 years ago & was turned away without even a prescription for pain, all while I was actively experiencing excruciating pain from an abscess and my face was swollen to double the normal size. Thanks for nothing. Worst experience at a dentist ever.

For all patient referrals, please fill out the referral form below.

Referring Dentist Details

Patient Details