January 20th, 2019

031-563 1665 info@rtortho.co.za

Dr. Renton Tindall Inc. Orthodontist B.D.S.,M.DENT. (Witwatersrand)

For Dentists

Help your patients to a more confident smile with specialist orthodontic treatment. Refer your patient now for an initial consultation at our practice.

Use our easy and convenient online referral form or call us for more details on 031 563 1665

Date
Name
Mother’s family name (if different from child)
Address
Postcode
Telephone
Date of birth

Referring practitioner details:

Your name
Your address
Your telephone
Your E-mail

Notes on patient:

Observations
Any relevant medical history
Enclosures
Word Verification:

Dr. Renton Tindall Inc. Orthodontist, Durban North, KwaZulu-Natal