Choose your referral



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