All referral letters should be concise, relevant and polite. In all cases the following information is required:
1. Name, title and address of person to whom you are referring the patient.
2. Patient’s name addresses and Date of Birth (DOB)
3. Reason for referral.
4. Request for advice and/or treatment.
5. Any previous relevant treatment carried out with dates.
6. Relevant medical/social history.
Specific referrals require further information:
Orthodontic referrals
- Diagnosis
- Patient’s attitude
- Previous orthodontic treatment
- Radiographs and study models
Oral surgery referrals
- History of complaint
- Suggested diagnosis
- Indication of urgency
- Relevant radiographs
Periodontal Referrals
BPE Score
Relavent Radiographs
Oral Hygeine History
Below is shown an example of an orthodontic referral letter:
Mr. X
Consultant Orthodontist
Hospital
Address.
Date
Dear Mr. X,
Patient’s name
Dob
Address
I should like to refer this 12-year-old girl for advice on the management of her mild Cl.II div. 1 malocclusion. She is unhappy about the appearance of her teeth and is prepared to wear an appliance.
Her oral hygiene is good and she is caries free. All teeth are present on radiograph. She has a 6mm overjet with an incomplete overbite.
The lower arch is well aligned but in the upper arch there is crowding with insufficient space for the canines which are palpable buccally. The upper incisors are proclined.
Would it be reasonable to?
1. Extract upper 4’s
2. Await eruption of upper 3’s
3. Fit URA to retract upper 3’s and to align upper incisors?
Thank you for seeing (Patient’s name).
Yours sincerely
Enclosures:
1 set study models
1 panoral Radiograph