Referrals - Bjärreds Tandläkargrupp

Submit Referral Form

Please fill out the form below and click “Submit.”

How is the information handled?

This page is SSL encrypted. The information sent through this form is encrypted and goes via our server in a secure way. No unauthorized person has access to the information.

Patient Information

First Name

Last Name

Date of birth

Phone

Street address

Postcode / city

Country

Diagnosis

The following treatments are suggested / desired

Any other important information

Implant System

Referring Dentist/Clinic

Date

ATTACH FILES - Max 20 MG per file. Max 100 MG in total.

Attached files

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Privacy Overview

This website uses cookies to improve your experience while you navigate through the website. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. We also use third-party cookies that help us analyze and understand how you use this website. These cookies will be stored in your browser only with your consent. You also have the option to opt-out of these cookies. But opting out of some of these cookies may affect your browsing experience.

Necessary

Always Enabled

Necessary cookies are absolutely essential for the website to function properly. These cookies ensure basic functionalities and security features of the website, anonymously.

Cookie	Duration	Description
cookielawinfo-checbox-analytics		This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Analytics".
cookielawinfo-checbox-functional		The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional".
cookielawinfo-checbox-others		This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Other.
cookielawinfo-checkbox-necessary		This cookie is set by GDPR Cookie Consent plugin. The cookies are used to store the user consent for the cookies in the category "Necessary".
cookielawinfo-checkbox-performance		This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Performance".
viewed_cookie_policy		The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. It does not store any personal data.

Functional

Performance

Analytics

Others

How is the information handled?

Patient Information

WE USE COOKIES ON THE WEBSITE