Orthodontic referral form - Vac Orthodontics 2025

1. Click ‘Get Form’ to open the orthodontic referral form in the editor.
2. Begin by entering the date at the top of the form. This helps establish a timeline for the referral.
3. Fill in the referring office details, including the dentist, hygienist, or staff name responsible for the referral.
4. Input the patient's full name, including first, middle, and last names as required.
5. Provide the patient's date of birth to ensure accurate identification.
6. Enter the parent or guardian's name along with their cell phone number and any other contact numbers available.
7. Include an email address for further communication regarding the referral.
8. Select all applicable reasons for referral from the provided options, ensuring you check any relevant clinical findings.
9. Add any additional comments that may assist in understanding the patient's needs.
10. Indicate how you will send the panoramic radiograph by checking one of the options provided.

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