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DENTIST REFERRAL

This patient referral form is for the use of dentists to refer their patients to us for orthodontic treatment.

PATIENT DETAILS

Please note: We cannot accept this referral unless ALL fields have been completed.

Date of birth
Day
Month
Year
Reason for referral
Private Assessment
OPT only
Informal opinion

REFERRER DETAILS

ATTACHMENTS

Upload any relevant photos and x-rays

dentist referral to orthdontist

SERVICES OFFERED TO REFERRING DENTISTS

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PANORAMIC X-RAY (OPT)

Referrals for OPT x-rays can be carried out privately for a fee to the patient of £60. Simply send us a referral form with a detailed justification (online or paper).

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CASE DISCUSSIONS/INFORMAL OPINION

If you have any queries about referring your patient for a consultation, we would be happy to discuss it with you. Some dentists regularly email radiographs or photos (with the patient’s consent) for a quick opinion. Remote consultations can offer an opportunity to discuss tricky cases.

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