5000N Off Dental Treatment

Thank you for being part of the Platinum Dental Surgery family! Refer someone you care about, and they will receive FREE registration and consultation. A digital coupon will be sent to their WhatsApp and email to redeem this special offer.

Patient Referral Nomination Form

Thank you for being part of the Platinum Dental Surgery family! Refer someone you care about, and they will receive FREE registration and consultation. A digital coupon will be sent to their WhatsApp and email to redeem this special offer.

Your Details (Referring Patient)

First Name *

Last Name *

Email Address

Phone Number *

Primary

Same As Whatsapp?

Yes

Whatsapp Number

Whatsapp Number #

Nominee Details (Referred Individual):

Nominee Name *

First Name and Last name

Nominee Email

Relation to Individual Relation to Individual

Nominee Phone Number *

Primary

Nominee Whatsapp

Add Another Contact Remove Contact

Patient Acknowledgment By signing this consent form:

I have read and understood the Patient Consent Form & Refund Policy provided by Platinum Dental Surgery. By signing below, I acknowledge and agree to its terms and conditions.

If you are human, leave this field blank.

Platinum Dental Surgery is the place to be.

Platinum dental surgery is the #1 destination for providing quality but affordable dental service(s) ranging from cosmetic dental treatment, orthodontic teeth alignment to minor and major oral surgeries in Nigeria. No matter how simple or complex the dental challenge is, there is always a solution. Do you desire a painless dental treatment? Platinum Dental Surgery is the place to be.

We have connections with several experts in the field of dentistry and that makes us stand out as a go-to dental clinic in Nigeria.

Creating New Smiles..

IKosi Ketu Branch

Lagos Island

Opening Hours

Support Center

5000N Off Dental Treatment

CALL +234 802 1818 185

REQUEST AN APPOINTMENT

Your Details (Referring Patient)

Nominee Details (Referred Individual):

Refer a family member or friend Optional

Platinum Dental Surgery is the place to be.

Support Center

Opening Hours

Creating New Smiles..

IKosi Ketu Branch

Lagos Island

Support Center

5000N Off Dental Treatment

5000N Off Dental Treatment

CALL +234 802 1818 185

REQUEST AN APPOINTMENT

Your Details (Referring Patient)

Nominee Details (Referred Individual):

Refer a family member or friend *Optional*

Platinum Dental Surgery is the place to be.

Support Center

Opening Hours

Refer a family member or friend Optional