Refer your patient to Improve Your Smile

    Requested treatment

    Attach patient files

    Send up to four files here (must be JPG files of less than 5mb each):

    If you have more files to send, please email them to

    Patient details

    Date of birth

    Referring dentist's details

    * = mandatory field

    Thank you for referring your patient to us. We will keep you informed as to our progress and any findings likely to affect their treatment now or in future. We undertake to refer your patient back to you at the end of their treatment with us.
    Dr Amjad Malik BDS DGDP RCS (UK), Lead Clinician, Improve Your Smile