Refer A Patient Refer a patient to Dental Health Spa by filling out the form below and we will contact the patient by telephone or email. Contact us We take Hygiene and Periodontal treatment Referrals for our Hygiene Team and also Dr Jenny Smith accepts Surgical Extraction Referrals. Please complete the form below. Practice name Phone no Email GDC no Practice address Title MR DR MISS MRS MS First name Surname Address Phone no Email Date of birth What are you being referred for? SUBMIT FORM How can we help? Name Email Phone Message Agree I agree with the Terms & Conditions SUBMIT