Orthodontics Referrals - Keyworth Dental Practice

We accept referrals from other Dentists for our specialist orthodontic service.

Please complete the form below to refer a patient to us for orthodontic treatment.
*Please note this is for private treatment only. Please see our criteria below.

Fields marked with an * are required

Referring Dentist Contact Details

Dentist name *

Dentist email *

Dental practice address *

Dental practice postcode *

Dental practice telephone number *

Have you previously referred a patient to us?

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Patient Information

Patient name *

Patient Email *

Patient Date of Birth *

Patient address *

Patient postcode *

Patient telephone number *

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Referral details

Reason for referral *

Case history *

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*Referral Criteria
Before a referral, please ensure your patients are dentally stable with no active periodontal problems with good oral hygiene. Those with facial profile concerns are better suited to NHS orthognathic referral pathways in secondary care. Please screen out patients with body dysmorphic disorder. Any patients whereby you need an opinion re poor prognosis 6s/impacted canines/ advice on development of their permanent dentition are better suited to NHS referral pathways due to ongoing review and very often need of interdisciplinary care. Please ensure digit sucking cessation advice has been given where relevant prior to referral.