NHS Orthodontic Referral Service

We welcome referrals for specialist Orthodontic treatment. Our aim is to work hand in hand with you to deliver a successful treatment outcome to your patients, whilst working in partnership with you to service and promote your practice.

Simply fill in the form below, or download and complete a pdf version.

Patient Details

Dental Insurance Cover

Reason for Referral


Image Upload

Upload any relevant photos or radiographs.
Accepted file types are jpg, gif, png or pdf.
Up to 5 files, max file size 10Mb.

Relevant Medical / Dental History

Referring Dentist Details