1st Floor, 3 Nottingham Street, Melton Mowbray, Leicestershire, LE13 1NN

Online Specialist Referral Form

At Melton Orthodontics, we are pleased to accept referrals from dental practices throughout the UK for all types of orthodontic procedures. From the 1st April 2018 however, NHS England require dentists to refer patients for NHS orthodontic treatment through the Referral Management Service (RMS). For more information about this facility, please either contact your Area Team or call us here at Melton Orthodontics on 01664 481048.

If you are a dentist and would like to refer an orthodontic patient to us for private treatment - simply complete the online form below and a member of our team will arrange an appointment for your patient and notify them by post. Please be sure to include your reason for referral. Alternatively, you can download the Specialist Dental Referral Form - pdf version, by clicking here and post it to us, enclosing any x-rays, covering letters or further necessary information.

  Download Specialist Referral Form as PDF

Specialist Referral Form

Patient Details
Referring Dentist Details
Further Information
Clinical Information - please tick one or more or provide IOTN
Referral Requirements
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Site last updated 25.01.2020