Dental Clinic van Mill

Referral

By filling out the application underneath you can refer one of your own patients to Dental Clinic van Mill

Referral

You may refer your patients to dental clinic van Mill for endodontic treatment, a consultation or second opinion.

In the case of an urgent referral, please contact the clinic directly and we will organize an appointment as soon as possible

Referrer / own dentist details
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Name
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E-mailadres
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Phone number
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Patient data
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First name
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Insertion
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Last name
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Date of birth
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Phone number
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E-mailadres
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Zipcode
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City
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Street address
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Preference of week/day/time
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Particulars (e.g. patient's anxiety, latex allergy, prophylaxis needed, etc.)
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Attachments (Referral letter, X-rays and additional files)
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Are you looking for a dentist?

Everyone is welcome with us. Even people who have not been to the dentist in years. We have a solution for every problem. Ask your question via the contact form or call us directly.