Get Orthodontic Referral Form

Completing the Orthodontic Referral Form online is an essential process for ensuring the appropriate care and treatment for patients needing orthodontic evaluation. This guide will assist you in accurately filling out each section of the form, providing clear and supportive instructions throughout the process.

Follow the steps to complete the Orthodontic Referral Form online:

1. Click ‘Get Form’ button to obtain the form and open it for viewing and editing.
2. Fill in the patient demographic details, including title, name, date of birth, gender, address, and contact information. Ensure that all fields are completed accurately.
3. Provide details of the referring practitioner, including their practice name, address, telephone, and email. This section is important for future communication regarding the patient.
4. Indicate whether an interpreter is needed by selecting 'Yes' or 'No'. This ensures clear communication throughout the treatment process.
5. Specify whether a copy of the referral has been given to the patient, and fill out the details of the referral, indicating the specialty referred to and whether the referral is for treatment, advice, second opinion, or urgent circumstances.
6. Outline the details of the problem, including the patient’s condition, diagnosis, and clinical circumstances. Provide any relevant medical and dental history to give the recipient an understanding of the case.
7. Indicate whether radiographs and study models are attached. If not, explain why they are not included.
8. Decide whether you want items returned to your practice and sign the form to certify the information provided.
9. Finally, review all information for accuracy and completeness. Once confirmed, you can save changes, download, print, or share the form as necessary.

Complete your Orthodontic Referral Form online today to facilitate timely and effective orthodontic care.