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 surgery

• Oral Surgery Referral Guidelines for GDPs Jan 2019
• Oral Medicine Referral Guidelines for GDPs Jan 2019
• Form 1: Adult – Oral & Maxillofacial Surgery Referral Form – DCIOS
• Form 2: GA or Sedation request form
• Form 2a – GA or Sedation Request Form (Electronic)
• Somerset Surgical Services (Weston General) – Oral & Maxillofacial Surgery Referral Form – Local Anaesthetic Service Only
• Bristol General oral surgery referral form
• Bristol Oral Medicine referral form
• Bristol Apical surgery referral form
• Bristol third molar referral form
• Bristol General Maxillofacial referral form
• 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 – Devon and Torbay
• 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

Orthodontic Dentistry

• NHS Orthodontic Referral Form V3 November 2019
• Cornwall, Devon, Somerset Orthodontics Patient Leaflet April 2019

Restorative Dentistry

• Guide to completing Restorative referral forms
• Restorative Referral Form
• Denture Referral Form
• Endodontic Referral Form
• Periodontal Referral Form
• Individual Funding Request Form (please refer to ‘exceptional clinical circumstances’ guidance)

Special Care & Paediatrics

• NHS England South West Referral Form Request for Assessment of Patients with Additional Needs (all services)
• Bristol Dental Hospital – Paediatric Dentistry Referral Form
• Bristol Dental Hospital – Paediatric General Anaesthetic Referral Form
• Plymouth Community Dental Services – Paediatric XGA Referral Form 2019
• Plymouth Community Dental Services – Adult Phobic Referral Form
• Great Western Hospital – Special Care Dental Referral Forms | Medical History Forms | Dental Referral Booklet
• Gloucestershire Community Dental Service referral forms and guidance

Special Care referral criteria and route by service: