Queensway Dental Clinic

Dental Referrals

Queensway welcomes referrals for NHS and private patients. Please see below the list of services that we offer and which patients they are suitable for.

You can refer a patient to us by printing and completing the PDF form and faxing it to our reception team on 01642 531799. Alternatively you can refer a patient securely online. For more information you can also read the accompanying policy documents.

Please note: there are Queensway Dental Clinic policies regarding referrals for Sedation and specific geographic-based policies for Oral Surgery (separate ones for both Darlington and Billingham referrals). Please read these documents before making referrals to Queensway.

We have set up this unique area so that you can refer patients quickly and securely. You will find both PDF and online versions of our referral forms: both have the same details requested. If you have any problems with the forms then do call us on 01642 554 667.

Conscious Sedation Referral Form (NHS and Private)

PDF Online Policy

Dental Implants Referral Form (Private)

PDF Online Info

Orthodontic Referral Form (NHS and Private)

PDF Online Info

Cosmetic Dentistry Referral Form (Private)

PDF Online

Periodontology Referral Form (Private)

PDF Online Info

3D Digital Imaging Referral Form (Private)

PDF Online Policy

Oral Surgery Referral Form (QTOSS/ Billingham) (NHS and Private)

PDF Online Policy

Oral Surgery referral form (QDDOSS/ Darlington and Durham) (NHS and Private)

PDF Online Policy

Endodontics Referral Form (Private)



PDF Online

Complex Case Referral Form (Private)

PDF Online