Patient Referral - Balbirnie Oral Care

Referral Request

Patient Referral Form

Patient Details

Patient's Title *

Patient's Surname *

Patient's First Name *

Patient's Address *

Patient's Town *

Patient's Postcode *

Patient's Date of Birth *

Patient's Phone Number *

Patient's Email Address *

Is the patient registered with a dental practice?*

Reasons for referral and/or provisional treatment plan

Additional details

Does the patient require sedation?*

Does the patient have a disability?*

Is the patient medically compromised?*

Referring Dentist Details

Name *

Email *

Address *

Town *

Postcode *

Contact Number *

Date *

Supporting attachments

You can attach one file using the input box below. Please use a zip file to send multiple attachments together.

Click or drag a file to this area to upload.

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Will supporting information be sent in the post?

To comply with data protection regulations (2018), we are unable to store and use your information unless you give us your permission. Please select Yes to allow this. View our data protection policy for details.*

Thank you for contacting us – we have received your form and will be in touch within 10 working days

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A good referral… What do we need from you?

Please provide as much information as possible.

An up to date MH is helpful.

Include any relevant radiograph. As per IRMER guidance, we will minimize the number of unnecessary or repeat radiographs and radiation exposure to patients. We have the latest digital OPT machine, offering segmental radiographs and CBCT. Your digital images can be emailed in via our secure web link. Hard copies can be posted in or given to your patient to bring with them to the appointment.

Telling your patient what to expect

Please do not ‘overbuild’ our procedures whilst discussing the referral with patients. Please explain simply as “It is a surgical procedure that I do not normally or frequently do. It will be straightforward in Balbirnie Oral Care’s hands because they do cases like yours every day.”

It is much more difficult for us to regain confidence and rationalise if the patient has the expectation that it will be terribly difficult. Sometimes a lavish description of flaps, extensive bone removal, division of roots, etc, doesn’t help the patient.

We have excellent video simulations for every procedure we offer. We also explain surgical technique in a simple, confidence-inspiring way.

Sedation referrals

We will gladly accept referrals for any of our treatments under IV sedation. We assess our sedation cases pre-operatively to ensure ongoing patient safety.

Our purpose built facilities include spacious operating surgeries with and adjacent recovery suite.

We continuously invest in staff training and use and maintain all recommended equipment. This, coupled with Dr Savin’s medical experience is our strength and really puts patient care as our top priority.

All of our dental nurses have undergone a post-qualification sedation course which contains theoretical and practical modules. They have all passed the exit exam and attend refresher courses biannually. They all bring extensive experience in providing treatment under sedation to the very neediest of patients.

We look forward to hearing from you and treating your referred patients.

You would be most welcome for an informal visit anytime.