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Self Referral - Download or Online

Option 1: Download Referral Form

You can download our self referral form by clicking here and sending it to us at:

  • Email: info@lakesideortho.co.uk
  • Address: 38 Salisbury Avenue, West Kirby, Wirral, CH48 0QP
  • Fax: 0151 625 0004

 

Option 2: Online Referral Form

Please fill in our online self referral form below:

We’ll use the information you submit to contact you regarding your enquiry. We’ll never share your information with a third party. Further information can be found in our Privacy Policy.

Ask us a question

If you would like to ask us a question regarding any of our services or treatments, please contact us below:
We’ll use the information you submit to contact you regarding your enquiry. We’ll never share your information with a third party. Further information can be found in our Privacy Policy.

Within this section

Lakeside TV

introducing lakeside

looking-after-your-brace

What our patients say...

  • Special thanks to Jonty for the amazing work you have done on my teeth. I am so happy with them, I can't stop smiling. My family and friends can't get over the difference............. I can at last say that I feel like the girl with the perfect smile. It was well worth going through the treatment and has given me the confidence to feel proud to show off my smile
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