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Dental Referral Form


(4.8 / 5) 60 votes
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Get your Dental Referral Form in 3 easy steps

  • 01 Fill and edit template
  • 02 Sign it online
  • 03 Export or print immediately

What Is a Dental Referral Form?

A dental referral form is a type of medical document you need to use to request dental services from another dental provider. This form is usually filled out by a dentist or other health care provider and then given to the dental clinic the patient wants to see. The referral form usually includes information about the patient's medical history as well as the reason for the referral.

Requirements for the Dental Referral Form

Before you take a referral to the dentist, you absolutely must consult with your primary care physician. Your dentist can direct you to the proper one, so you can receive the best dental treatment plan.

Your printed dental referral form should be filled out by your dentist with the following required information:

  • Patient name, date of birth, and contact information. A complete description of the dental problem, current health status, and previous medical records. Dentist's name, practice name and contact information.
  • You and the dentist should sign a standard dental referral form. The referral form needs to be sent to the dental clinic or dentist you want to consult. Likewise, your referral form should arrive at the dental clinic or dentist at least 2 weeks before your appointment.

If you have questions about the printed referral form, you can contact the dental clinic or dentist for more information.

How to Write a Dental Referral Form?

A dental referral form is a document used to refer a patient to the dentist. The dental referral form PDF must include the patient's name, address, phone number, and the name of the referring dentist. The form should also include the reason for the referral and the name of the dentist the patient will see.

What Is a Dental Referral Form Needed For?

A dental referral form helps dentists refer patients to specialists. The dentist referral form includes information about the patient's medical history and dental treatment, as well as the referring dentist's recommendations.

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Fillable online Dental Referral Form
(4.8 / 5) 60 votes
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