ONLINE DENTIST REFERRAL

ENDODONTICS

Clair graduated from University College Cork in 2005 and completed the MSc in Endodontics at the Eastman Dental Institute in 2012.
Clair is available to accept Endodontic referrals from your dental practice to her Endodontic practice located in Mitchelstown.
Clair is available to accept emergencies and trauma cases.
Clair also available to discuss any endodontic cases over the phone.

Please provide as much detail as possible on the referral form, including any treatment difficulties that it would be beneficial for us to know about before we meet the patient.

Please don’t hesitate to contact us.

Please send your referral via email to Dr. Clair Nolan at the following address: nolandentalmitchelstown@gmail.com or complete the online referral below.

01.Patient Details

Name

Email *

Tel

Address

DOB

02.Referring Dentist’s Contact Details

Dentist Name

practiceemail *

Practice Tel

Practice Address

Date of Referral

03.Reason for referral

Reason for referral

04.Relevant medical history

05.How would you like the tooth returned ( tick box option)

Tooth Returns *

Permanent core

Temporary core

Final restoration including crown

07.Additional info

By filling in this form you consent to your data being stored by Nolan Dental. We will only use this information to contact you about your specific query. The information you provide will not be used for any other purpose.

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