309 Kempshott Lane, Basingstoke RG22 5LY

Email: basingstokeortho@gmail.com



Patient Referral Form


Basingstoke Orthodontics is pleased to be the major provider for NHS orthodontics in the area. This allows us to provide NHS orthodontic treatment to young people under 18 with moderate to severe problems with their bite or tooth alignment. Anyone under the age of 18 is eligible for a free orthodontic consultation; you will need to be referred to us by your dentist.


The annual funding for orthodontic treatment under the NHS is limited each year and those who do qualify for treatment may have to join a waiting list before treatment can begin. If you do not qualify for NHS treatment we also offer private care, which is available for all ages and can offer a number of benefits over NHS care, including flexible appointment times and a wider choice of the braces.


For up to date advice on NHS referrals please go to:


01. https://secureservercdn.net/


02. https://secureservercdn.net/


Patients who would like to be seen privately do not require a referral from their General Dental Practitioner. The fee for a 40 minute orthodontic assessment is 100 and this includes full orthodontic record taking and treatment planning with the Specialist Orthodontist. Any necessary photographs, study models and X-rays will be taken at that appointment. The Orthodontist will formulate a treatment plan and you will go away with a summary of the cost of treatment.




Referring Dentist / Practice Name

Referring Dentist Telephone

Referring Dentist Email

Referring Dentist Address

Patient Name

Patient address and Telephone

Medical History of Patient

Treatment Required

Patient's Date of Birth