Dentist Referrals

I confirm that the patient:Has good oral hygieneWants to have orthodontic treatmentIs in permanent dentition

NHS or Private:NHS (you must be under 18 years of age to be eligible)Private

NHS Patient Number:

Eg. 458-478-8759

If the patient is not in the permanent dentition stage please specify reason for referral (failure to do may result in the referral form being returned)

Please provide as much detail as possible to prevent any unnecessary delays to your patients.