Manhem Implant Centre

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As a dentist you may refer patients for further treatment at Manhem Implant Centre. We are available to accept referrals for all treatments that are mentioned in our services section. A referral may be submitted electronically via the form below or by post, using our referral form. We can send you a set of referral forms or you may download and print it yourself here.

Several of the fields in this form are markred with a red * these are a requirement for the form to be sent to us, however please fill in as many of the fields as possible.

Details of Referring Dentist

Details of Patient