Linden Cottage Endodontic Form

Endodontic Form

Relevant Medical & Social History:

Tooth to be Assessed:

Referral notes including any previous treatment:

Radiographs or Photographs attached:

Yes No

Upload attachment:

Additional comments:

I confirm that the patient has consented to this referral and is happy for Linden Cottage to contact them to arrange an assessment appointment:

Yes No

After endodontic treatment and unless otherwise requested, your patient will be returned to you for cuspal coverage restoration (where necessary) and continuing care.