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Refer a Patient

Joburgdental would like to thank you in advance upon considering us for patient referral. Please use the form below to provide referral details.

Patient Information

Completed Treatments

Digital Radiographs & Pictures
Please attach all relevant digital radiographs.
Note: If you have problems attaching the images, please email us the radiographs at

For Periodontal Evaluations: The most Recent FMX
For Implant, Crown Lengthening or Graft Evaluation: Pertinent Peri-apical X-rays


Referring to Doctor: Rakesh Chandran

Referring Doctor Information