Get Orthodontic Referral Form

This guide aims to assist you in accurately completing the Orthodontic Referral Form online. The process is straightforward, and by following the steps outlined below, you will ensure all necessary information is provided for a seamless referral.

Follow the steps to fill out the Orthodontic Referral Form with ease.

1. Click the ‘Get Form’ button to access the Orthodontic Referral Form and open it in your preferred document editor.
2. Begin by entering today's date in the designated section at the top of the form. This helps track when the referral was made.
3. Introduce the patient by filling in their name clearly. Ensure the patient's telephone number is accurate, as it will be important for follow-up communications.
4. Complete the referring dentist or physician’s information by providing the necessary details including name, address, and phone number. This identifies who is making the referral.
5. Indicate the reason for referral by checking the appropriate boxes under 'Patient has been referred for the following'. You may select multiple options that apply.
6. Record any specific concerns the patient has by checking the relevant boxes under 'Patient's concerns'. This should reflect the issues that warrant the referral.
7. If applicable, indicate the required radiographs by selecting the appropriate options. This ensures that the necessary imaging is available for the orthodontist.
8. Use the section for any special instructions or remarks to provide additional information that may assist in the referral process.
9. Once all the sections are filled out thoroughly, save your changes, and download a copy of the form. You can choose to print it for physical delivery or share it electronically as needed.

Complete your Orthodontic Referral Form online today to facilitate seamless patient referrals.