REFER PATIENTS to ALEX NIKOLAOU

To refer a patient, please complete the form below

Dentist's Name *

Dentist's Contact Number *

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Please give details of the referral and please include any treatment already carried out. *

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Select the appropriate teeth for assessment (upper) * UR8 UR7 UR6 UR5UR4UR3UR2UR1UL1UL2UL3UL4UL5UL6UL7UL8

Select the appropriate teeth for assessment (lower) *LR8LR7LR6LR5LR4LR3LR2LR1LL1LL2LL3LL4LL5LL6LL7LL8

Patient's Name *

Patient's Date of Birth *

Patient's Address *

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Post Code

Patient's Email

Patient's Contact Number

Relevant Medical History and Current Medications

Smoker *YesNo

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Specialist-led dental implant care across Manchester & Chester, delivering advanced implant solutions with precision, long-term stability and a personalised treatment journey from consultation to final smile.

Request Consultation Call 0161 327 3277

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Locations

Deva Dental Clinic
Deva Dental Clinic

Travel from

Hale
South Manchester
Central Manchester

Get in touch

0161 327 3277
alex@dralexnikolaou.co.uk

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