Referral Form


  • Date Format: DD slash MM slash YYYY

  • Date Format: MM slash DD slash YYYY


    Most orthodontic treatment is carried out for children aged 10 years+, and once the permanent dentition is established Exceptions to this rule, when referral in the mixed dentition is appropriate, are:
    • Anterior or posterior crossbites
    • Asymmetry in the pattern of tooth eruption (e.g. a lateral incisor erupts before a central)
    • Molars of Poor Prognosis (seek opinion before extracting)
    • Lack of palpable canine bulges buccally (age 10+)
    • Hypodontia
    • Supernumerary teeth
    • Submerging deciduous molars
    • Impacted teeth
    Otherwise, please delay referral until the first premolars have erupted.

    Thank you for your referral.
    Elsey & Elsey | 01285 860712 |