PATIENT SELF-REFERRAL

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Patient details

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By submitting this form, you are aware of the consultation fee at Sunrise Dental Clinic:

*Orthodontic consultation with the Specialist Orthodontist/ Free

*Paediatric consultation with the Specialist Paediatric Dentist/ £200

*Paediatric consultation with Dentist with Special Interest in Paediatric Dentistry/)/ £150

*Consultation with Specialist Oral Surgeon/ £150

*Consultation with General Dentist/ £110

*Consultation Jaw Joint and occlusion Expert/ £150

*Hygiene First Visit/ £120

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