Get the free orthodontic referral form

Date Rec d for internal use Universal Orthodontic Referral Form Only referrals made on this form will be accepted for NHS orthodontic treatment in North East South East Wales PLEASE PRINT CLEARLY USING BLACK INK Referral to Referring Practitioner Name Address Practice Stamp GDP Details if different Patient Details Date of Birth Address including postcode Age / Contact Telephone Numbers REFERRALS WILL BE SENT BACK TO THE REFERRING PRACTITIONER IF ALL THE RELEVANT INFORMATION ON THIS FORM IS...

How to fill out orthodontic referral form

How to fill out orthodontic referral form:

1. Start by filling out your personal information such as your name, date of birth, and contact information.
2. Next, provide details about your primary dentist or referring dentist, including their name, address, and contact information.
3. Indicate the reason for the referral, whether it's for consultation, specific treatment, or any other orthodontic need.
4. Include any relevant dental and medical history, such as allergies, previous orthodontic treatment, or current medications.
5. Specify any orthodontic concerns or issues you have that require attention or treatment.
6. If you have dental insurance, provide your insurance information, including the company name, policy number, and group number.
7. Finally, sign and date the referral form before submitting it to the orthodontic office or your desired orthodontic specialist.

Who needs orthodontic referral form:

1. Individuals seeking orthodontic treatment or consultation.
2. Patients whose primary dentist or healthcare providers recommend additional orthodontic evaluation or treatment.
3. Patients who want to explore orthodontic options beyond the scope of their primary dentist's expertise.

For pdfFiller’s FAQs

How can I send orthodontic referral form for eSignature?

orthodontic referral form is ready when you're ready to send it out. With pdfFiller, you can send it out securely and get signatures in just a few clicks. PDFs can be sent to you by email, text message, fax, USPS mail, or notarized on your account. You can do this right from your account. Become a member right now and try it out for yourself!

How can I get orthodontic referral form?

It's simple using pdfFiller, an online document management tool. Use our huge online form collection (over 25M fillable forms) to quickly discover the orthodontic referral form. Open it immediately and start altering it with sophisticated capabilities.

Can I edit orthodontic referral form on an Android device?

You can edit, sign, and distribute orthodontic referral form on your mobile device from anywhere using the pdfFiller mobile app for Android; all you need is an internet connection. Download the app and begin streamlining your document workflow from anywhere.

What is orthodontic referral form template?

An orthodontic referral form template is a standardized document used by dental practitioners to refer patients to an orthodontist for specialized treatment.

Who is required to file orthodontic referral form template?

Dentists and dental professionals who identify the need for orthodontic evaluation or treatment in patients are required to file the orthodontic referral form template.

How to fill out orthodontic referral form template?

To fill out the orthodontic referral form template, the referring dentist should provide patient information, clinical findings, treatment history, and their professional observations, along with the reason for referral.

What is the purpose of orthodontic referral form template?

The purpose of the orthodontic referral form template is to facilitate communication between the referring dentist and the orthodontist, ensuring that all pertinent information is conveyed for accurate diagnosis and treatment planning.

What information must be reported on orthodontic referral form template?

The information that must be reported on an orthodontic referral form template typically includes patient demographics, medical history, dental history, clinical examination results, and specific concerns or conditions observed by the referring dentist.