Dentists in Edgware Road, London, W2

For Dentists

Dentist Referrals

Dr Athyr Al-Killidar is recommended by a number of dental practitioners for the treatment of Orthodontic and TMJ problems. He is an Invisalign Platinum Elite Doctor and is experienced with conventional orthodontics, Lingual braces and Damon braces. He is a member of the British Orthodontic Society, and his treatment philosophy is to base treatment planning on facial profile and health of the TMJs. If you would like to recommend a patient, you can either:-

Download a Form, complete it and send/ fax it to our Practice

Orthodontic and TMJ referral

Patients Details
Title:
Date of Birth:
Surname:
Forenames:
Address
Postcode
Telephone/ Mobile
E-mail
Treatment requirement TMJ
Medical History
   
Referring Practitioner
Full Name
E-mail
Observations
   
If you have any digital radiographs or images that you would like to send with this referral, please e-mail them to athyr@londonsmile.com
 
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CBCT referral (Online Form)

Dr Athyr Al-Killidar
Patient Referral - CBCT
Marble Arch Dental Centre
217 Edgware Road,
London
W2 1ES
Sender Details & Delivery Address
Payment:
Doctor Patient
Email:
Patient Details
Appointment Date:
Name:
Surname:
DOB:
Tel:
Mobile:
Output
CD Email
Screenshot by printout Memory Stick

Investigation Required
Dental Panoramic Tomograph
Lateral Cephalometric Radiograph
CBCT

Indicate Teeth and Area of Interest:

Mandible (6cm) Maxilla (6cm)
Both Jaws (6cm)    

18

17

16

15

14

13

12

11

21

22

23

24

25

26

27

28

48

47

46

45

44

43

42

41

31

32

33

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36

37

38

Is the patient coming with a radiographic template?
Yes No
Possibility of pregnancy?
Yes No
   
Reason for Scan
Ortho
Impacted teeth
Perio
Other
Special Instructions
 
Format
Kodak Imaging Software (Free) DICOM Files
Name of practitioner
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Email:
Enquiry:
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Marble Arch Medical & Dental