Get the free Orthodontic Referral Form

Complete the UTHSC Orthodontic Referral Form for a thorough evaluation including airway concerns, overbite, spacing issues, and more.

How to fill out orthodontic referral form

How to fill out orthodontic referral form

1. Gather all necessary patient information such as name, contact information, date of birth, and reason for referral.
2. Fill out the referring dentist's information including name, contact information, and dental license number.
3. Provide detailed information about the patient's dental history, current concerns, and any relevant medical conditions.
4. Include any supporting documentation such as X-rays, photos, or previous treatment records.
5. Double check all information for accuracy and completeness before submitting the form.

Who needs orthodontic referral form?

1. Orthodontists
2. Dentists referring patients for orthodontic treatment
3. Patients seeking orthodontic consultation

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What is orthodontic referral form?

Orthodontic referral form is a document used by dentists to refer their patients to an orthodontist for specialized treatment.

Who is required to file orthodontic referral form?

Dentists are required to file orthodontic referral form when they want to refer a patient to an orthodontist.

How to fill out orthodontic referral form?

To fill out an orthodontic referral form, dentists need to provide patient's information, reason for referral, and any relevant dental records.

What is the purpose of orthodontic referral form?

The purpose of orthodontic referral form is to facilitate the communication between dentists and orthodontists and ensure that patients receive appropriate treatment.

What information must be reported on orthodontic referral form?

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