Dental treatment (Kent) referral form

GDP?

If you are a GDP please send all referrals to East KENT Community on the REGO systems as notified by NHS England. Any referral’s from GDPs on this site will be rejected.

Referral criteria

Group 1 | Special needs - unable to receive GDS

Group 2 | Special needs - shared GDS/CDS

Group 3 | Paedodontics - behavioural issues

Group 4 | Gerodontics - complex ageing dentition

Group 5 | Periodontics - please complete Periodontal referral form

Group 6 | Patients who are unable to access NHS dental care

Group 7 | Children in care

Group 8 | Bariatric

Group 9 | Domiciliary

At least one needs to be ticked in this section.

Weight*

*mandatory for bariatric referrals

Please complete the following eligibility criteria for domiciliary oral healthcare (group 9).

Does the patient attend his/her doctor?

Yes

No

Does the patient have someone to bring them to the surgery?

Yes

No

If the patient has a hospital appointment, how does he/she get there?

Ambulance

Taxi

Car

Bus

Does the patient use a taxi for other activities?

Yes

No

The patient...

walks unaided

is a wheelchair user

needs assistance

is confined to home

Medical history

Relevant medical history: Please state any health issues or medications which we should be aware of(Required)

Treatment attempted/received

Treatment attempted/received(Required)

Recommended

Services

Pages

Leaflets

Dental treatment (Kent) referral form

Your information

GDP?

Referral criteria

Patient details

Medical history

Treatment attempted/received

Reason for referral and treatment required

Referrer's details

Radiographs enclosed?