IV Sedation Referrals

At Pollok Dental Care we provide safe intravenous sedation for anxious patients, we are happy to take your referrals. Please do this online by completing the form as fully and accurately as possible
We would ask you to pre- screen your referral patient by assessing BMI and checking the relevant medical history. If in doubt call the practice prior to referral
During the sedation treatment blood pressure and oxygen saturation are closely monitored to ensure the safest treatment
Please complete the details below and attach or send appropriate radiographs for the patient

    Has the patient had previous IV sedation?

    I enclose all relevant radiographs (emailed or jpeg)

    I confirm I have assessed the above patient, discussed and agreed the above treatment

    The patient is aware that a non refundable consultation fee of £50 is payable prior to the first appointment and
    the total fee for the sedation aspect of the treatment is £150 regardless of payment exemption status