Dental Referrals

Our state-of-the-art clinic is modern, welcoming, and designed with your comfort and accessibility in mind. Our facility and surgeries are all on the ground floor, and we have a wheelchair accessible car park, entrance, bathroom, and seating so all our patients can get the care that they need. Hilton Dental Clinic is also a specialist referral centre, receiving referrals from around 50 practices across the East Midlands for complex extractions (including impacted wisdom teeth) and dental implants.

Referring Practitioner Details

Dentist Name(Required)

First Last

Practice Address(Required)

Street Address Address Line 2 City Post Code

Practice Phone(Required)

Practice Email(Required)

Patient Details

Patient Name(Required)

First Last

Patient Date of Brith

Patient Address(Required)

Street Address Address Line 2 City Post Code

Patient Phone(Required)

Patient Email(Required)

Referral Details

Reason for referral(Required)

Please provide further information to help us understand why your are referring this patient:(Required)

X-Rays / Other Scans

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Monday	: 08:30 - 5:00
Tuesday	: 09:00 - 5:30
Wednesday	: 08:30 - 5:00
Thursday	: 08:30 - 5:00
Friday	: 08:30 - 4:00
Weekends	: Closed