For colleagues

Refer a patient

Patients referred for treatment return to your practice for their routine, ongoing dental care afterwards — referrals are treated as time-limited collaborations, not patient transfers.

I prefer to upload a referral letter
Write your referral as you normally would and upload it instead of completing the patient sections below. Word, PDF, JPEG or PNG. Your own details and the consent confirmation are still required. You can still attach photographs or radiographs in the attachments section below.

Section 01

Referring dentist details

First name *

Surname *

Practice name *

Practice phone number *

I may reply by email, phone or WhatsApp.

Practice email *

Practice address *

Section 02

Patient details

First name *

Surname *

Date of birth *

Phone number *

I may reply by email, phone or WhatsApp.

Address *

Email address *

Used to notify the patient that their referral has been sent to Jurgita Sybaite at Dr Jurgita Smiles.

Relevant medical history

Requested treatment *

Section 03

Referral details

Urgency *

Routine

Urgent

Pain or trauma

Description of the problem / referral notes *

Up to 4,000 characters — roughly a page of A4.

Section 04

Attachments

Optional photographs, radiographs or STL scans. Up to 15 files, 500MB each.

Section 05

Consultation fee

Who will pay for the consultation? *

Patient

Referring practice

Section 06

Consent

I confirm that the patient has consented to this referral and to their personal and clinical information being shared with Dr Jurgita Smiles for the purpose of assessment and treatment planning. *

The patient has also agreed that their treatment photographs may be used in case studies and educational materials shared by Dr Jurgita Smiles.

Prefer to talk it through first? Call +44 7777 595555 or email info@drjurgitasmiles.com.