Choose your referral
- Click on the form below
- Print the form, and enter dentist and patient details
- Post the form to – Attention: Orla – Dentist Referral, Ennis Orthodontic Practice, Unit 12A Westgate Business Park, Kilrush Road, Ennis, County Clare.
- Once we receive the form, we will send a confirmation email to you
- We will contact the patient directly to arrange a consultation appointment
