Get the free Referral form Periodontics - dentistry utoronto

Print Form 124 Edward Street, Toronto, Ontario M5G 1G6 416 979-4905 ext. 4576 Fax 416 979-4755 REFERRAL TO THE GRADUATE PERIODONTAL CLINIC Referring dentist: Date: / / Specialty: Address: City/Postal

How to fill out referral form periodontics

How to fill out a referral form periodontics:

Start by filling out your personal information:

1. Write your full name, address, and contact information.
2. Include your date of birth and gender.

Fill out your dental history:

1. Indicate if you have any previous dental issues or treatments related to periodontics.
2. Provide any relevant information about previous periodontal treatments or surgeries.
3. Mention any existing medical conditions that may be relevant to your periodontal health.

Include the reason for referral:

1. Specify the symptoms or issues you are experiencing that require a referral to a periodontist.
2. Explain any specific concerns you have regarding your gum health or periodontal condition.

Provide information about your general dentist:

1. Write the name, address, and contact information of your regular dentist.
2. Include the reason why your dentist referred you to a periodontist (e.g., for further evaluation, specialized treatment, etc.).

Indicate any relevant insurance information:

1. If you have dental insurance, provide the details of your insurance provider.
2. Include your insurance policy number and any necessary contact information.

Include any additional information:

1. If there are any other relevant details or special instructions, make sure to mention them in this section.
2. You may want to include a list of medications you are currently taking or any allergies you have.

Who needs a referral form periodontics?

Patients experiencing gum disease:

1. Individuals with symptoms of gum disease such as swollen or bleeding gums, bad breath, or loose teeth may need a referral to a periodontist.
2. Patients who have gum recession or deep pockets around their teeth are also good candidates for periodontal treatment.

Those in need of dental implants:

1. Patients who require dental implants to replace missing teeth may need a referral to a periodontist who specializes in implant dentistry.
2. Dental implants require periodontal expertise to ensure successful placement and integration with the surrounding gum and bone.

Patients with complex periodontal issues:

1. Individuals with severe or complex periodontal diseases that require specialized treatment or surgical intervention may need to be referred to a periodontist.
2. Conditions such as aggressive periodontitis, periodontal abscesses, or recurring periodontal infections may necessitate a referral.

In summary, filling out a referral form periodontics requires providing personal information, dental history, reason for referral, details of your regular dentist, insurance information, and any additional relevant details. Referral forms are typically needed for patients experiencing gum disease, those in need of dental implants, or individuals with complex periodontal issues.

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What is referral form periodontics?

Referral form periodontics is a document used to refer a patient to a periodontist for specialized gum treatment.

Who is required to file referral form periodontics?

Dentists or dental professionals who identify a need for periodontal treatment for a patient are required to file the referral form periodontics.

How to fill out referral form periodontics?

To fill out a referral form periodontics, the referring dentist must provide the patient's information, reason for referral, relevant medical history, and any other pertinent details.

What is the purpose of referral form periodontics?

The purpose of referral form periodontics is to ensure that patients receive appropriate periodontal care from a specialist when needed.

What information must be reported on referral form periodontics?

Information such as patient demographics, referral reason, medical history, and any relevant diagnostic results must be reported on referral form periodontics.