Dental Referral Form
The Dental Referral Form helps general dentists, physicians, or healthcare providers refer patients to dental specialists in a clear and professional format. It captures all the details the specialist needs to begin treatment without delay.
It improves communication and provides a smooth patient handoff.
About this template
This form collects referrer details, patient information, reason for referral, and any attached reports or x-rays. It’s ideal for use between clinics, hospitals, and dental specialists like orthodontists or oral surgeons.
Why Use This Dental Referral Form?
Missing referral info can lead to delays, confusion, or repeated tests. This form ensures you send everything needed in one go—patient background, symptoms, and supporting files.
You save time for both offices and give the patient a more seamless care experience.
It works for emergency referrals, second opinions, or routine specialist consultations.
Smart Features That Keep Referrals Clear and Efficient
Upload x-rays, reports, or previous dental charts → Enable file uploads
Collect digital consent from patients before sharing sensitive data → Enable electronic signature
Add dropdowns for referral type: ortho, surgery, periodontics, etc.
Automatically notify the receiving clinic once a referral is submitted
Export referral forms as PDFs to attach to patient records
How to Use This Form
Click Use Template
Customize fields for referral type, clinic policies, and patient symptoms
Include your contact info and any guidelines for referral processing
Share the form with providers or allow access from your clinic site
Track, export, and review all referrals in your dashboard
Use this form to reduce referral delays, improve communication between providers, and ensure patients get the dental care they need—without extra admin work.
Frequently Asked Questions
Yes, you can easily add custom fields to collect detailed information like medical history, insurance details, and specific dental concerns.
You can set up automatic confirmation emails to send to the patient once their referral is received.
Yes, Formester allows integration with appointment scheduling systems, making the process seamless.
Yes, you can track where each referral came from by adding a field for the referral source (e.g., dentist, family, etc.).
Yes, you can send a link to the form via email or add it to your website.
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