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Dentist Online Referral Form

Thank you for choosing L&L Orthodontics as your referral partner.

We really appreciate your trust in us to support your patients’ smile and oral health.

If you’d like to refer a patient for specialist orthodontic care - including braces or clear aligner treatment - please complete the form below. Our team will reach out to them promptly to arrange next steps.

Dentist Online Referral Form

Referring Dentist Details

Patient Details

Referral Information

Please include reason for referral and specific problem areas.

Please upload any relevant documents that will help our team (for example medical history form or OPG and Lat Ceph scans).
Accepted file types: jpg, gif, png, pdf

Select Files

For further information about how we use your data, please see our privacy policy.