Online Referral – Endo – Glumangate Dental Practice, Chesterfield

Consultation - £45

Root Canal Treatment
Non-Molar (1-5) - £465
Molar - £615

Re-Root Canal Treatment
Non-Molar (1-5) - £595
Molar - £695

Apicectomies (1-5 only) - £695

CBCT as part of endodontics treatment – Free of charge

Dentist Name:

Practice Name:

Practice Address:

Email Address:

Title:

First Name:

Last Name:

Address:

Date of Birth:

Phone Number:

Email Address:

Relevant Medical History:

Drugs:

Allergies:

Reason for Referral:
Please specify tooth/teeth which require treatment, as well as details of any treatment already carried out.

Please tick here if referral is urgent and patient in pain
Please tick here if referral is urgent/patient is in pain

Online Referral – Endo