Refer a patient

For dentists and GPs wishing to refer a patient, or for patients who would like to refer themselves.

Once we receive your referral, it will be reviewed and we’ll contact the patient directly to arrange a consultation.

Referral form

Please complete the form below with the relevant clinical information and ensure the patient’s contact details are correct.

Fields marked are required.

Referrer details

Your name

Practice

Practice address

Contact number

Email address

Patient details

Patient name

Date of birth

Patient address

Contact number

Email address

What is the referral for?

Clinical summary The problem and what you would like done, relevant medical history and current medication, and whether the patient is particularly anxious

If you have radiographs, please send them from a secure account to referrals@oralsurgerynottingham.co.uk, quoting the patient’s name and the date each image was taken.

I confirm I may share these details for the purpose of this referral, and that they may be used to arrange the patient’s consultation.

This form is not monitored continuously and should not be used for urgent problems. For a patient in severe pain, with significant swelling or difficulty breathing or swallowing, contact the practice by phone, NHS 111, or the nearest emergency department.

What happens next

Once the referral has been reviewed, we will contact the patient directly to arrange a consultation.

We will keep you informed throughout the patient’s treatment. Once treatment is complete, a letter summarising the care provided will be sent to you, and the patient will be returned to your care for any ongoing treatment or follow-up required.

If you would rather discuss a case before referring it, call the practice on 0115 960 3572 or email referrals@oralsurgerynottingham.co.uk. See the full referral pathway.