Get the free Endodontics Patient Referral Form - uthsc

UT HSC College of Dentistry Advanced Specialty Education Program in Endodontics 5th floor, Dunn Dental Building 875 Union Ave, Memphis TN 38163 Tel: 901-448-1546 Fax: 901-448-1541 email: ending UTC.edu

How to fill out endodontics patient referral form

Who needs endodontics patient referral form?

1. Dentists who want to refer their patients for endodontic treatment.
2. Endodontists who receive referrals from other dentists.

How to fill out endodontics patient referral form?

1. Start by providing the patient's basic information, including their name, contact details, and date of birth.
2. Next, indicate the referring dentist's information, such as their name, practice name, and contact information.
3. Specify the reason for the referral, whether it is for diagnosis, treatment, or consultation.
4. Include relevant dental history, detailing any previous treatments, medications, or allergies the patient may have.
5. Describe the specific tooth or teeth requiring endodontic treatment, including the tooth number and any symptoms.
6. Attach any relevant radiographs or images that support the referral.
7. Indicate the desired outcome or goals for the referral, such as preserving the natural tooth or resolving a specific issue.
8. Provide any additional notes or comments that may assist the endodontist in understanding the patient's condition or concerns.
9. Finally, ensure that all necessary signatures are obtained, including both the referring dentist and the patient if required.
10. Once completed, send the referral form to the appropriate endodontic office for review and scheduling of the patient's appointment.

For pdfFiller’s FAQs

What is endodontics patient referral form?

The endodontics patient referral form is a document used by dental professionals to refer a patient to an endodontist for specialized treatment of root canal issues.

Who is required to file endodontics patient referral form?

Dental professionals, such as general dentists, are required to file the endodontics patient referral form when they need to refer a patient to an endodontist for specialized treatment.

How to fill out endodontics patient referral form?

To fill out the endodontics patient referral form, dental professionals need to provide the patient's contact information, details about their dental issue, and any relevant dental records or X-rays. They also need to include their own contact information and sign the form.

What is the purpose of endodontics patient referral form?

The purpose of the endodontics patient referral form is to facilitate the seamless transfer of a patient from a general dentist to an endodontist for specialized root canal treatment. It ensures that all necessary information is documented and shared between dental professionals.

What information must be reported on endodontics patient referral form?

The endodontics patient referral form typically requires the reporting of the patient's name, contact information, dental issue, previous dental treatments, any relevant X-rays or dental records, and the referring dentist's contact information.

How can I send endodontics patient referral form to be eSigned by others?

When your endodontics patient referral form is finished, send it to recipients securely and gather eSignatures with pdfFiller. You may email, text, fax, mail, or notarize a PDF straight from your account. Create an account today to test it.

Where do I find endodontics patient referral form?

It’s easy with pdfFiller, a comprehensive online solution for professional document management. Access our extensive library of online forms (over 25M fillable forms are available) and locate the endodontics patient referral form in a matter of seconds. Open it right away and start customizing it using advanced editing features.

How do I edit endodontics patient referral form on an iOS device?

Use the pdfFiller app for iOS to make, edit, and share endodontics patient referral form from your phone. Apple's store will have it up and running in no time. It's possible to get a free trial and choose a subscription plan that fits your needs.