Get the free Orthodontic Referral Form - Monkstown Dental

Orthodontic Referral Form REFERRING DENTIST Name: Tel: Address: Fax: Email: Post code: Date: / / / / PATIENT DETAILS Name: Home Tel: Address: Work: Mob: Post code: D.O.B.: Is this referral urgent?

How to fill out orthodontic referral form

How to fill out an orthodontic referral form:

1. Start by carefully reading the instructions provided on the form. This will give you a clear understanding of what information is required and how to fill out each section accurately.
2. Begin by providing your personal information. This typically includes your name, contact details, date of birth, and any relevant insurance information. Make sure to double-check the spelling and accuracy of this information.
3. Provide the name and contact details of your referring dentist or healthcare professional. This is crucial to ensure that your orthodontist can communicate effectively with the person who referred you.
4. Indicate the reason for the referral. Include any specific concerns or issues that have prompted the need for orthodontic treatment.
5. Fill out the medical history section. Provide details about any past or present medical conditions, medications, allergies, and surgeries. It is important to disclose all relevant information, as certain medical conditions can impact orthodontic treatment.
6. If applicable, provide information about any previous orthodontic treatment you have undergone. This includes details about the type of treatment and the name of the orthodontist who provided the treatment.
7. Briefly describe your dental history. Include any past or ongoing dental problems, procedures, or surgeries you have had. This helps the orthodontist assess your overall oral health before starting treatment.
8. Answer any additional questions or requests made on the form. These may vary depending on the individual orthodontic practice, but they typically aim to gather more information about your specific orthodontic needs.

Who needs an orthodontic referral form?

1. Individuals seeking orthodontic treatment usually require a referral form from their general dentist or healthcare professional. This ensures a coordinated approach to their dental care and allows the orthodontist to have access to necessary information about the patient's oral health.
2. Referring dentists or healthcare professionals who identify orthodontic issues in their patients may also need to fill out an orthodontic referral form. This allows them to provide essential details about the patient's dental history, treatment objectives, and any other relevant information.
3. Orthodontic specialists often rely on referral forms to gather crucial information about a patient before the initial consultation. This helps the orthodontist assess the patient's needs accurately, plan their treatment, and provide specialized care.

Overall, orthodontic referral forms play an instrumental role in ensuring effective communication and coordination between the general dentist, referring professional, and orthodontist, ultimately leading to quality orthodontic treatment outcomes.

For pdfFiller’s FAQs

What is orthodontic referral form?

Orthodontic referral form is a document used to refer a patient to an orthodontist for evaluation and treatment of misaligned teeth or jaws.

Who is required to file orthodontic referral form?

Dentists, dental hygienists, or other healthcare providers who identify the need for orthodontic treatment in a patient are required to file orthodontic referral form.

How to fill out orthodontic referral form?

Orthodontic referral form can be filled out by providing patient demographics, reason for referral, dental history, and any relevant radiographs or documentation.

What is the purpose of orthodontic referral form?

The purpose of orthodontic referral form is to facilitate the referral process, ensuring that patients receive appropriate orthodontic care.

What information must be reported on orthodontic referral form?

Information such as patient's name, contact information, dental insurance, reason for referral, and any relevant dental history must be reported on orthodontic referral form.

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