| Name | Description | Type | Additional information |
|---|---|---|---|
| ReferralTreatment | string |
None. |
|
| Otherreason | string |
None. |
|
| Dentistname | string |
None. |
|
| Clinicname | string |
None. |
|
| ClinicAddress | string |
None. |
|
| Clinicphonenumber | string |
None. |
|
| clinicemail | string |
None. |
|
| Patientname | string |
None. |
|
| PatientDOB | string |
None. |
|
| PatientAddressPostCode | string |
None. |
|
| Patientemail | string |
None. |
|
| Preferredclinic | string |
None. |
|
| Howheard | string |
None. |
|
| Status | string |
None. |
|
| Notes | string |
None. |
|
| ContactNumber | string |
None. |