Referrals

IMI Clinic

At the IMI Clinic we welcome periodontal referrals. We are delighted to work closely with referring practitioners, offering our help and expertise for all aspects of patient care from the treatment planning process through to the execution of treatment.

If you wish to refer your patient to IMI Clinic for periodontics please complete and submit the referral form. Alternatively, you can write to us or e-mail us at leeds@imimail.com. Please feel free to send any additional information which you feel might be useful such as radiographs. We will contact the patient to arrange an appointment and keep you informed of their progress at every stage. All referred patients are returned to the care of their dentist.

We provide the highest level of care for all our patients. Our commitment to excellence will ensure that your patient will receive dental care of the most superior calibre.

Thank you for your referral.

Dentist name*
Dentist Email*
Dentist Address
Dental practice telephone number*

Patient Information

Patient name*
Patient Address*
Patient telephone number*

Referral Details

Reason for referral
Medical history
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