We welcome all referrals from our dental colleagues whether they are NHS or Private patients.
Please use the links below to refer your patients on the appropriate referral form.

NHS Referrals

From January 2016 NHS England require all NHS orthodontic practices in Surrey, Sussex and Kent to use NHS England's patient referral form for anyone under the age of 18, who qualifies for NHS treatment.

The form is a Microsoft Word document and can be downloaded from the link below. Completed forms must be emailed to

Download the NHS Patient Referral Form


The IOTN Scale - Does your patient qualify for NHS treatment?

All dentists not trained in the IOTN scale should either tick one box in Part C or write their Observations in Part E on the NHS Form in order to know whether the patient qualifies for NHS treatment. If you are unsure about the IOTN scale, it can be downloaded by clicking the button below:

Download the IOTN scale PDF


Private Referrals

All children who fall below the IOTN 3.6 threshold (please refer to the IOTN chart if you are unsure) and all adults over the age of 18 years should be referred using our Private Patient Referral Form below.

Download Private Patient Referral Form PDF


Contact US Book your consultation now


Ewell Orthodontics

175 Kingston Road


Surrey KT19 0AA


Tel: 020 8394 2324

Fax: 0208 394 2343


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Opening times


08:30 - 17:20


08:00 - 14:00

Some Tuesdays we are open until 7pm.
Call for more information.