General dentistry Paedodontics Endodontics Periodontics Radiography and diagnostic Implantology
Oral SurgeryOrtodonticsImplantology

Select a Specialist Service

Please either fill in the form below or send an email to referrals@30awimpole.com,
providing information on both the patient you are referring and your dental practice.

step 1 of 4

Select a Specialist Service

Oral Surgery(Dr George Paolinelis)Orthodontics (Dr Heike Bornert)Implantology (Dr George Paolinelis)

step 2 of 4

Patient details

Title: Mr.
Title: Mr.
Title: Ms.


Date of birth

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1
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31

January
January
February
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April
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June
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August
September
October
November
December

1940
1940
1941
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1943


step 3 of 4

Referral’s details



Every referral patient will return to their original practice once treatment with our specialists is complete – unless otherwise requested.

During the treatment process, we will keep you informed about your patient’s progress. However, if you have any further questions, please do not hesitate
to get in touch with us.

step 4 of 4

Referral details

Oral Surgery (Dr George Paolinelis)Orthodontics (Dr Heike Bornert)

File Attachments*

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