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 Head and Neck Cancer Referral Form 2 Week Wait – Somerset
• 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

Oral Surgery and Oral Medicine Guidance

• MCN oral surgery referral guidelines for gdps March 2023 V4
• Oral Medicine Referral Guidelines for GDPs Jan 2019

Oral Surgery Referral Forms

• General Oral Surgery referral Form 23.05.2023 v3
• 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-23.05.23 v3
• Soft Tissue Oral Surgery Referral Form 28.03.2023 (1)
• Apical-surgery-referral-form-23.05.23 v3
• Somerset Surgical Services (Weston General) – Oral & Maxillofacial Surgery Referral Form – Local Anaesthetic Service Only
• Bristol Oral Medicine referral form

Maxillofacial Referral Forms

• Bristol General Maxillofacial referral form
• Maxillofacial Referral Form – Sompar

Orthodontic Dentistry

• Orthodontic Individual Funding Request (IFR) Form 2022
• NHS Orthodontic Referral Form V3 November 2019
• Cornwall, Devon, Somerset Orthodontics Patient Leaflet April 2019
• Plymouth Orthodontic Referral Pack
  • Plymouth Orthodontic referral guidance
  • Plymouth patient information for Orthodontic referral
  • Plymouth Orthodontic referrals covering letter
  • Plymouth Orthodontic referral form

Restorative Dentistry

• Guide to completing restorative referral forms
• Individual Funding Request (IFR) Form Restorative Dentistry
• Restorative Referral Form
• Denture Referral Form
• Referral Rejection Restorative
• Endodontic Referral Form
• Perio Referral Form

Special Care Dentistry – Adults

Referral Forms

• Special Care adults referral form for dentists – April 23
• Special Care adults referral form for health and social care professionals – April 23

 Guidance

• Guidance for referral to Special Care for non dental health and social care professionals – April 23

Referral Criteria

Special Care referral criteria

Paediatrics

• Special Care Children referral form
• Bristol Dental Hospital – Paediatric Dentistry Referral Form
• Bristol Dental Hospital – Paediatric General Anaesthetic Referral Form
• Plymouth Community Dental Services Paediatric XGA Referral Form 2019
• Gloucestershire Community Dental Service referral forms and guidance

Referral Criteria

See table above for referral criteria and routes for referrals.