Working together for their smile

Referral Form for Dentists

Dental Works Kids welcomes referrals from dentists and parents across Essex and beyond.

All our referrals are quick and straightforward.

We offer a referral service for:

  • Sedation dentistry (inhalation and IV)
  • Interceptive and early orthodontics
  • Tongue tie and lip tie assessment
  • Molar incisor hypomineralisation (MIH)
  • Complex paediatric hygiene needs
  • Anxious or nervous child patients

If you wish to make a referral, you can complete the online form below.

Dental trauma or facial swelling?

Please call us directly on 01277 600 111 rather than using this form, so we can arrange to see the patient as quickly as possible.

Patient Information
Date of Birth
Gender (assigned at birth)
Patient Address
Parent/Guardian Contact Details
Relevant medical history or disability
Current medication
Is the patient under hospital care?
Reason for referral
Clinical details
Urgency
Radiographs available?
Attach relevant X-rays or photos (taken within the last 12 months)
Name for Referring Dentist
Dental Practice Address
Practice Contact Details