Referrals

Refer a patient

Dr Samy adamantly believes that a referred patient must be treated for what the referrer has requested, and not beyond. Dr Samy will never provide additional treatments to referred patients without first seeking the approval of the referrer. Whilst Dr Samy cannot deny access to his services, he will always give honest advice, and will never seek to entice patients from referrers.

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Referrer’s details

Referrer’s Name

Referrer’s Email

Referrer’s Phone Number

Treatment requested

Patient’s details

Patient’s Name

Patient’s Email

Patient’s Phone Number

Please tick this box to confirm that you have discussed this referral with the patient and they have agreed for you to share their personal information.

Contact Dr Samy directly instead

Get in touch via:
Email: samy@dakatra.co.uk
Phone number:
London: 0330 122 5182
Dubai: 04 343 5051