PortmanDentex Referrals

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Mr Robert Banks

GDC: 68014

Biography

Bio coming soon

Treatments Offered

Oral and Maxillofacial Surgery (Specialist)

Education

FDS Royal College of Surgeons Of England 1997 BDS Newcastle University 1992

Practices

Please choose one of the following:

Queensway Jesmond

1st Floor, 13 Eslington TerraceJesmondJesmond NE2 4RJ

Queensway Dental Billingham

170 QueenswayStockton-on-TeesBillingham TS23 2NU

Locations

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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

Practice address line 2

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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