Refer your patients with confidence at Charisma Clinic

If you're a dentist looking to refer a patient to one of Charisma Clinic's dental experts, please use our online referral form below.

Please be assured that we will neither approach nor accept your patient for non-referred treatment.

Referring Dentist's Details








Specialist Treatments Required

Referred Patient's Details









Reason for Referral

Upload your Photo:

Please upload any supporting documents or Xrays

Please note: Photos should be JPG & no larger than 1MB. All photographs submitted to us will be kept strictly confidential and not shared with any third party.

I confirm I have read & agree to your privacy policy.

Please be patient when submitting large images. We will redirect you to a confirmation page after this form has been processed.

Where we are

  • 6 Chepstow Drive
  • Hazel Grove
  • Stockport
  • Cheshire SK7 4RY

Getting in touch

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Surgery hours

  • Mon - Fri: 9am – 5pm
  • Saturday: 9am - 1pm

Useful Forms:

Denplan CQC GDC Zoom Whitening Colgate Philips Sonicare