How to refer hygiene patients

If you would like to refer a patient to Devonshire House for hygiene treatment you can either:

Refer by post or fax

PRINT OFF AND RETURN A PAPER PATIENT REFERRAL FORM

Refer by phone

Contact our Reception Team on 01223 245266

Refer online

Online referral allows you to upload radiographs, photographs or any additional patient documentation as attachments.

Your Contact Details

Referred Patient

Relevant Medical History

Dental Anxiety Score

BPE

Please provide numbers

Periodontal Condition Diagnosis

Treatment Required

Please select treatments required:

Teeth for specific attention

Upper Left
Upper Right
Lower Left
Lower Right

Areas for special attention

Accompanying Documents

Please upload radiographs, photographs or patient documentation as attachments below.

Enclosures

Local Anaesthetic used by Devonshire House

CITANEST
Citanest 3% with Octapressin infiltrations if required.
Use up to 3 x 1.8 ml cartridges as required
ARTICAINE
Alternatively use 4% Articaine with 1:200K adrenaline.
Use up to 2x 1.8 ml cartridges as required
ORAQIX
25/25 mg per gram cartridges for pocket anasthesia.
Up to 2 x 1.7 ml cartridges per case.

On Completion of treatment

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