Referral Form

We welcome your referrals to Michael Shipway & Associates Dental Clinic.

We look after patients:

  • A team that truly cares for them
  • A bespoke personal service
  • A full range of modern dental treatments
  • A comfortable, pleasant, enjoyable and relaxing environment

To refer your patient, you have three options:

  1. You can either fill in the Referral form below OR
  2. Download the Referral form, print it out, fill it in and then send to Michael Shipway & Associates Dental practice.
  3. Contact us on 01242 522161 or email


Click here to download the Michael Shipway Referral form.

You can also download the Michael Shipway Medical History Form PDF by clicking here.


Please fill in as many details as you can.  Fields which have this symbol * need to be filled in.

 Please note that when you click the SUBMIT Button at the bottom, all your details will be sent via email to Michael Shipway & Associates and are completely confidential.