Referrals

Homepage
What are Dental Implants?
FAQ’s
Fee’s Guide
Gallery
Referrals
About The Dentists
Contact Us
Location Map
Site Map

Dr Pat Kilker

More

Referrals

    Patients Details

    Title

     First Name

    Surname

    Date of Birth

    Address

    Postcode

    Telephone No. Home:

    Telephone No. work:

    Mobile

    Detail reason for referral:

    Specify any relevant
    medical History:

    Add any other information
    you think may be helpful:

    Referred By:

    Referring
    Dentist Details:

    Title

    First Name

    Surname

    Practice Name

    Address

    Postcode

    Telephone No.

    Nature of treatment ?

    Preferred
    treatment Location

    Dr. P.G. Killer
    54,High Street
    Easington Lane
    Houghton-le-Spring
    Tyne and Wear
    Dh5 OJN
    Tel. 0191-5264905
    Fax. 0191-5261983
    Email:[email protected]

    Am I too old to have dental implants ?
    There is no upper age limit for patients to underg…

    Is everyone a candidate for implant treatment ?
    In general, anyone healthy enough to undergo routi…

    More FAQ’S>

    The Association of Dental Implantology

    TOP | Homepage | What are Dental Implants? | FAQ’s | Fee’s Guide | Gallery | Referrals | About the Dentists
    Site developed by Five Rivers | IT Support | Internet Marketing