Get the free Orthodontics referral form - Dental Faculty Practice - smileexperts osu

ORTHODONTIC PATIENT REFERRAL FORM Fourth Floor, Apostle Hall 305 W. 12th Avenue Columbus, OH 43210 (614) 2921472 office (614) 2924960 factor Delhi DDS, PhD, MSDZongyang Sun DDS, MS, MSD, PhD Henry

How to fill out orthodontics referral form

How to fill out orthodontics referral form

1. Start by filling in the patient's personal information, such as their name, date of birth, and contact details.
2. Indicate the reason for the referral, including any specific orthodontic concerns or issues that need to be addressed.
3. Provide a brief medical history of the patient, including any relevant dental or medical conditions that may affect orthodontic treatment.
4. Include any previous orthodontic treatment the patient has received, such as braces or aligners.
5. Specify any radiographs or X-rays that should be attached to the referral form for further evaluation.
6. If the referral is for a specific orthodontist or dental specialist, provide their contact information and any additional instructions.
7. Ensure that the referral form is signed and dated by the referring dentist or healthcare professional.
8. Once completed, make a copy of the referral form for your records and send the original to the intended recipient.

Who needs orthodontics referral form?

1. Orthodontics referral forms are typically needed for patients who require specialized orthodontic treatment.
2. This includes individuals who may have dental alignment issues, malocclusions, or other orthodontic concerns.
3. These forms are usually filled out by dentists or other healthcare professionals who are referring the patient to an orthodontist or dental specialist for further evaluation and treatment planning.

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What is orthodontics referral form?

An orthodontics referral form is a document that is used by healthcare providers to refer patients to an orthodontist for evaluation and treatment.

Who is required to file orthodontics referral form?

Typically, general dentists or primary care providers are required to file an orthodontics referral form when they identify a patient needing orthodontic treatment.

How to fill out orthodontics referral form?

To fill out an orthodontics referral form, the referring practitioner should provide patient information, medical and dental history, and specific reasons for the referral, along with any relevant diagnostic records.

What is the purpose of orthodontics referral form?

The purpose of the orthodontics referral form is to provide essential information to the orthodontist to facilitate an accurate assessment and treatment plan for the patient.

What information must be reported on orthodontics referral form?

The orthodontics referral form must report the patient's contact information, medical history, dental history, the reason for referral, and any pertinent diagnostic information or findings.