Referral form Health or Social Care Professional

Referral to the service does not guarantee acceptance. A referral will be triaged and a decision will be made about whether a patient is able to be appropriately cared for by our service. In some cases we may not be the most appropriate service to manage the patient’s care needs. The outcome of a referral will be communicated back to referrer with information about other services should they be more appropriate.

People from the following groups can be referred to the service:

  • People with learning disabilities

  • People with autistic spectrum disorders

  • People with acquired brain injuries

  • People with a diagnosed mental health illness

  • People with medical conditions which are affected by poor oral health or where the provision of dental treatment is complicated by that condition

  • People with a physical disability that makes accessing the General Dental Service more difficult

  • People with a sensory disability that makes accessing the General Dental Service more difficult

  • People with a  current substance misuse habit

  • Children who are very anxious, uncooperative preschool children or a child with a phobia of dental treatment

  • Children with repaired cleft lip or palate

  • “Looked after” children or those registered as “At risk”

  • Oral Surgery

Section 1 - Patient details

Our main clinics are Exeter or Barnstaple, but we also run satellite clinics in the following locations. Would the patient be willing to travel to any of these locations for assessment and or treatment (please tick any that the patient would be willing to travel to). Wherever possible we will try and offer the clinic closest to the patients home address.
Safeguarding concerns