A range of downloadable referral forms and related guidance documents are available below for practices, covering areas of dental specialty and location specific requirements.

Only use secure NHSmail

All referrals and any communication containing patient identifiable information must be made using a secure NHSmail account only. All dental practices must have at least one NHSmail address – if you need to set up a new account please visit the NHSmail website for details and join via the NHSmail portal tool for dentistry.

Oral Cancer 2 Week Wait Referral Forms – South West

• Suspected Head and Neck Cancer Referral Form 2 Week Wait – BNSSG
• Suspected cancer referral – For Somerset facing dental practices, please email ereferrals@somersetft.nhs.uk for further information and the Suspected Cancer Proforma.
• Suspected Head and Neck Cancer Referral Form 2 Week Wait – Cornwall
• Suspected Head and Neck Cancer Referral Form 2 Week Wait – Gloucester Royal Infirmary
• Suspected Head and Neck Cancer Referral Form 2 Week Wait – Bath Royal United Hospital
• Suspected Head and Neck Cancer Referral Form 2 Week Wait – GWH Swindon (referrals via John Radcliffe Oxford)
• Suspected Head and Neck Cancer Referral Form 2 Week Wait – Salisbury and Poole
• Suspected Head and Neck Cancer Referral Form 2 Week Wait – Dorset
• Suspected-Head-and-Neck-Cancer-Referral-Form-2-Week-Wait-Devon

Maxillofacial Referral Forms

• Bristol general maxillofacial referral form

Oral Surgery and Oral Medicine Guidance

• MCN Oral Surgery referral guidelines for GDPS  Dec 2023 v7
• Oral Medicine Referral Guidelines for GDPs Jan 2019

Oral Surgery Referral Forms

• General-Oral-Surgery-referral-Form-21.06.2023-vs4
• Oral Surgery GA Shortened Request Referral form 28.03.2023-v2
• Oral Surgery Shortened Sedation Referral form 28.03.2023-v2
• Oral-Surgery-THIRD-MOLAR-referral-form-21.06.2023-vs4
• Soft-Tissue-Oral-Surgery-Referral-Form-21.06.2023 vs2
• Apical-surgery-referral-form-21.06.23 v4
• Somerset Surgical Services (Weston General) – Oral & Maxillofacial Surgery Referral Form – Local Anaesthetic Service Only
• Bristol oral medicine referral form
• NHSE Southwest Unerupted Tooth of Concern OS referral Form July 2023 vs 2

Orthodontics 

• South West Regional Orthodontic Referral Form August 23
  South West Orthodontic Provider List
• SW Orthodontic Referral Acknowledgement Form
• Orthodontic Individual Funding Request (IFR) Form 2022
• Orthodontic Referral Guidance South West
• Plymouth Orthodontic Referral Guidance
  • Plymouth Orthodontic referral guidance
  • Plymouth patient information for Orthodontic referral

Paediatric Dentistry

• Paediatric Secondary Care Form-GA
• Acceptance Criteria V3
• Paediatric CDS Form – GA (Plymouth CDS)
• For Paediatric Referrals to Community Dental Services please refer to Special Care below.

Restorative Dentistry

• Individual Funding Request (IFR) Form Restorative Dentistry
• Perio Referral form Oct 2023
• Denture Endo Restorative Referral form Oct 2023
• Guide to Completing Referral Forms V3

Special Care Dentistry – Adults and Children

• Special Care Dentistry Referral Form for Dentists to CDS – Adults and Children – Feb 2024
• Special Care Dentistry Referral Form to CDS for Health and Social Care Professionals – Adults and Children – Feb 2024
• Special Care Dentistry Referral Form for Children – Bristol Dental Hospital only
• Special Care Dentistry Referral Form for Adults – Bristol Dental Hospital only

 Guidance

• Guidance for referral to Special Care Dentistry CDS for Adults and Children by non dental health and social care professionals –

Special Care referral criteria