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Aesthetic Dental Studio · Marbella · Estepona · Riviera · acedntl.com

Referral

Oral surgeon

Patient
Personal ID no.
Date of birth
Referred to
SpecialtyOral surgeon
UrgencyRoutine
Referring dentistDr. Arsalan Korkchi, licensed dentist
ClinicACE DNTL STUDIO, Marbella
Place and dateMarbella, 19 June 2026

Dear colleague,

Reason for referral

I hereby refer the above patient for assessment and, if appropriate, treatment.

The reason for referral is specified in the clinical assessment and any accompanying documentation.

Clinical findings

Relevant clinical and radiographic findings are enclosed and can be supplemented on request.

Request

I would value your assessment of the patient regarding oral surgeon and your recommendation for further management. Assessment may follow your usual scheduling.

A note with your assessment and proposed treatment would be much appreciated. Please do not hesitate to contact me should you need any further information.

Dr. Arsalan Korkchi

Licensed dentist

ACE DNTL STUDIO, Marbella

Reg. no. / Nº colegiado

Clinic stamp

Marbella · España · acedntl.com

This referral is sent collegially. The patient has been informed of and consented to the referral.