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Referrals: NHS

This is the NHS referral form.

Note to referring dentists

Please be aware when you are referring a patient to our practice that due to the lockdown and Covid 19 restrictions we are busy seeing patients who currently have a brace. Therefore, if you wish to refer a new patient please inform them that our waiting list is at least 6 MONTHS for a consultation.

  • Please complete this form for any patient in need of NHS orthodontic treatment ensuring that they:

  • To aid your grading of the IOTN please download the easy IOTN app:
    iPhone: https://itunes.apple.com/gb/app/easy-iotn/id1144560762?mt=8
    Android: https://play.google.com/store/apps/details?id=com.vincentharding.EasyIOTN&hl=en_GB
  • Patient details

  • Details of Referrer

  • GENERAL MEDICAL PRACTITIONER details

  • Reason for referral

  • Please complete NEED FOR TREATMENT for any patient requiring NHS orthodontic treatment.
  • NEED FOR TREATMENT (IOTN SCORE)

  • PLEASE CONFIRM THE FOLLOWING:

  • Yes
    No
  • Radiographs