Confused about cosmetic dentistry options?

23 Stockbridge Road, Winchester, SO22 6RN

CBT Referral Form

We’d like to introduce you to the Solutions Dental Clinic Referral programme. As a referral clinic we can act as an extension of your existing practice, enabling you to offer clients full treatment plans which include Denture Provisions and CBCT Scanning.

Our aim is to offer your practice unparalleled support with complete transparency and integrity. We will keep you up to date every step of the way and ensure that your patient is referred back to your clinic for aftercare and ongoing management.

Please fill out the form below and one of our team members will be in touch with you shortly to discuss next steps.

Please note we cannot be responsible for any malware or virus contained in the USB.

A referral is compulsory and required before sending a patient to us from another dental practice, without this we cannot book the patient in 

1Referring dentists details

2Patient details

3Justification of x-ray

Justification of x-ray

4Field required

Field required

5Account settled by:

Account settled by

6File upload of a radiograph or photo

Drop files here or
Max. file size: 8 MB, Max. files: 10.


    Average customer rating 5 Highly recommended