Dentist NHS referral

All NHS referrals must be submitted on the Essex NHS Orthodontic referral pro-forma. Please ensure the form is completed in full, so that each case can be accurately assessed for its level of urgency.

All referrals are triaged and appointments are issued accordingly. If you’re unsure about any part of the referral, please don’t hesitate to contact our team for guidance.

Patient Information

Is the patient in the permanent dentition stage? *
Is the patient’s oral hygiene good? *
Is the patient willing to have orthodontic treatment? *
Reason(s) for referral*

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