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 requires 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 using the button below and post it to us, enclosing any x-rays, covering letters or further necessary information.

Patient details

Referring dentist details

Further details

Clinical Information - please tick one or more or provide IOTN

Referral requirements

Tick all that apply

For further information about how we use your data, please see our privacy policy.