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Lead Nurse: Stacey Murphy Tel: 01727 732053 Email: HCT.hertsdentaldoms NHS.net Out of hours contact number: 111Domiciliary Dental Service 09:00 17:00 Monday to Friday Unit 10, Tandridge Gate Business
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How to fill out domiciliary dental treatment request

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How to fill out domiciliary dental treatment request

01
To fill out a domiciliary dental treatment request, follow these steps:
02
Obtain the domiciliary dental treatment request form from your dental care provider or download it from their website.
03
Fill in your personal information, including your name, address, and contact details.
04
Provide details about your dental condition, such as the symptoms you are experiencing or the reason for the treatment.
05
Indicate if you have any dental insurance coverage and provide the necessary insurance information.
06
If you have a preferred dental care provider, mention their name and contact information.
07
Specify if you require any specific accommodations for domiciliary dental treatment, such as wheelchair access or medical assistance.
08
Sign the form and date it before submitting it to your dental care provider.
09
Keep a copy of the filled-out form for your records.
10
Follow any additional instructions provided by your dental care provider regarding the submission of the request.

Who needs domiciliary dental treatment request?

01
Domiciliary dental treatment request is needed by individuals who are unable to visit a dental care provider's clinic or facility due to various reasons, such as physical disabilities, medical conditions, or age-related limitations.
02
This request allows individuals to receive dental treatment in the comfort of their own homes or residential care settings.
03
It is commonly required by elderly individuals, individuals with disabilities, or individuals who are unable to leave their homes easily.
04
The request ensures that necessary dental care is provided to individuals who cannot access traditional dental facilities.
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Domiciliary dental treatment request is a request for dental treatment provided in a patient's home or care facility.
Patients who are unable to visit a dental clinic due to medical reasons or mobility issues are required to file domiciliary dental treatment request.
Domiciliary dental treatment request can be filled out by the patient's caregiver or healthcare provider, providing all necessary information about the patient's condition and treatment needs.
The purpose of domiciliary dental treatment request is to ensure that patients who are unable to visit a dental clinic receive necessary dental care in their home or care facility.
Domiciliary dental treatment request must include patient's personal information, medical history, treatment required, and details about the patient's home or care facility.
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