NHS Dentist Referral

All NHS referrals must be submitted on the Essex NHS Orthodontic referral pro-forma. Please ensure the form is completed in full, so that each case can be accurately assessed for its level of urgency.

All referrals are triaged and appointments are issued accordingly.

First Name

Last Name

DOB

Gender

Address

Telephone

Mobile Number

Date of Referral

Reasons for Referral

IOTN(DHC)

Impacted/Ectopic teeth / supporting radiograph must be attached

Overjet ( Measured in mm)

Overbite

Mild Mod Severe

Crowding

Mild Mod Severe

Spacing

Mild Mod Severe

Missing Teeth

Yes No

Crossbites

Yes No

Radiographs Attached

Yes No

Medical Conditions

Other info

Name of Dentist practitioner

Email of Dentist practitioner

GDC Number

Practice Address

Attached Files

What happens at your appointment?

Here is what you can expect when you book a free consultation at Colchester Orthodontic Centre:

You’ll be welcomed by our friendly admin team before meeting our Treatment Coordinator, who will take the time to understand your concerns and smile goals.

They will organise a 3D scan of your teeth which will be assessed by one of our experienced Specialist Orthodontists remotely. Your Treatment Coordinator will then explain your treatment options and discuss estimated treatment timelines.

You’ll receive an estimate for the investment in your new smile and information about our flexible payment and financing plans.

If you’re ready to move forward, we’ll walk you through the next steps and help schedule a full assessment with a Specialist Orthodontist.

Specialist consultation

If you’d prefer a direct consultation with one of our Specialist Orthodontists, this is available for a fee of £195. During the appointment, our specialist will carry out a comprehensive examination of your teeth and discuss the most suitable treatment options for your unique smile.