Community dental - Referral form

Please give as much detail to support your referral as possible.

With effect from 12 March 2018
For General Dental practitioners wishing to refer a patient into the Community Dental Service this should be done via the DERS- Vantage REGO system. After this date all other electronic and paper referral systems will be no longer valid and the referral will be returned to referrer as per NHS England guidance.

To find out how we use this information, our security and your rights visit our privacy page.

You will see a thank you page once the form has been submitted. If you do not see this page then you have overlooked to complete some of the required fields. Please check the form, complete the missing details and resubmit. Thank you.