PortmanDentex Referrals

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Professor Leandros Vassiliou

GDC: 148739

Biography

Consultant Oral & Maxillofacial Surgeon Head and Neck Reconstructive Surgeon GMC: 7019987

Treatments Offered

Oral and Maxillofacial Surgery (Specialist)
Oral Surgery (Specialist)
Oral Medicine (Specialist)

Education

DipDS (Athens) 2002, MD, MSC, MRCS, FRCS(OMFS), Honorary Lecturer in Medicine of Liverpool

Practice

Apollonia House Dental & Implant Clinic

167 Mossley RdGrasscroftManchester OL4 4HA

Location

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Referral Form

Patient Details

Patient first name

Patient last name

Address line 1

Address line 2

Town or city

Postcode

Country

Date of birth

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Phone number

Patient Consent Received

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Referring Practitioner

Practitioner first name

Practitioner last name

Practitioner email

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Referring Practice

Practice address line 1

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Practice town or city

Practice postcode

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Referral Details

Primary reason for referral

Preferred Treatment for Referral

Observations and Dental History

Medical History

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