Get the free Orthodontic Patient Referral Form

Orthodontic Patient Referral Form Introducing:___ Telephone:___Email:___ Referred By:___ Date:___Please Check the Desired Treatment: General Orthodontic Evaluation Space Maintenance Evaluation Orthognathic

How to fill out orthodontic patient referral form

How to fill out orthodontic patient referral form

1. Obtain the orthodontic patient referral form from the orthodontist's office.
2. Fill out the patient's personal information such as name, date of birth, address, and contact information.
3. Provide details about the patient's dental history and any previous orthodontic treatment.
4. Include information about the reason for the referral and any specific concerns the orthodontist should be aware of.
5. Sign and date the form before submitting it to the orthodontist's office.

Who needs orthodontic patient referral form?

1. Dentists, general practitioners, and other healthcare providers who wish to refer a patient to an orthodontist for specialized treatment.

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What is orthodontic patient referral form?

An orthodontic patient referral form is a document used by dentists to refer patients to orthodontists for specialized treatment related to dental misalignments and orthodontic issues.

Who is required to file orthodontic patient referral form?

Typically, general dentists who identify the need for orthodontic treatment in their patients are required to file the orthodontic patient referral form.

How to fill out orthodontic patient referral form?

To fill out the orthodontic patient referral form, the referring dentist should provide patient information, dental history, specific concerns or conditions, and any relevant radiographs or diagnostic records.

What is the purpose of orthodontic patient referral form?

The purpose of the orthodontic patient referral form is to communicate the patient's dental needs and history to the orthodontist, ensuring that the patients receive appropriate and timely treatment.

What information must be reported on orthodontic patient referral form?

Information that must be reported includes the patient's personal details, medical history, dental examination findings, any previous treatments, and specific reasons for the referral.