Referrals for all aspects of fixed and removable prosthodontic care are welcome. A strict policy is adopted to ensure the patient is discharged back to your continuing care following completion of the prescribed treatment, and I will work with you to ensure your patient needs are fully catered for.

Please email me at or use the online form below. Alternatively, you can print the form below and post it to the preferred practice address.

Online Referral Form

Patient Details

Date of Birth

Referring Dentist Details

Akil Gulamali Limited. Registered Office:Network House, Station Yard, Thame, Oxon OX93UH. Registered in England and Wales 9284784. 

                                                                                                                                                                                                                                    © 2012 Akil Gulamali. All rights reserved.

                                                                                                                                                                                                                                                              Last updated: Dec 2016