MOS Referral Form

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Please note: Information on this page is for GDP use only.

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Thank you for referring patients to NHS IMOS service provided by VSS.

We kindly ask you to send the completed referral form along with radiograph to the following address:

nhsdental.wlondon.vssv04853@nhs.net

NB. Please use secure nhs.net email when sending referrals electronically.

The referral form can be downloaded below. We also have a non-editable example form that can be downloaded for reference.