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Referring Practitioner

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Medical History

Oral Health

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Level of Urgency

Referral Details

Referral Treatment*
I would like to be present during the consultation/treatment
I would like you to contact me to discuss the case
I would like you to treat as you see necessary and let me know of your plan for this case
I would like to restore this case (implant placement only)
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    Kissdental

    Manchester

    City Centre
    13 Stanley Street
    Manchester
    M8 8SH
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    Kissdental

    Altrincham

    2 New Street
    Altrincham
    Cheshire
    WA14 2QS
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    Kissdental

    Flixton

    157 Woodsend Road
    Flixton
    Manchester
    M41 8GN
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    Kissdental

    Knutsford

    The Brookdale Centre
    Manchester Road
    Knutsford
    Cheshire
    WA16 0SR
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    Kissdental

    Alderley Edge

    55A London road
    Alderley Edge
    Cheshire
    SK9 7DY
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    Kissdental

    Liverpool

    Ground floor, Copper House
    21 The Strand
    Liverpool
    L1 8LT
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    Kissdental

    Bramhall

    32 Woodford Road
    Bramhall
    Stockport
    SK7 1PA
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