Community Dental Services Referral Criteria
Adults and Children with Additional Needs
Many children and adults with special needs are normally treated within the General Dental service.
However, because of a patient’s particular needs a GDP may not have the specialist skills or
equipment and facilities to provide the high quality care appropriate to the needs of the patient and
they may wish to make a referral to CDS.
Please note: this criteria for acceptance of referrals has been set by NHS Bedfordshire. If the referral
does not comply with the criteria and/or insufficient information / inadequate x-rays are provided, it
will not be accepted.
Making a referral
The following information should be submitted as a minimum:

Patient’s details including name, date of birth, address and daytime telephone number

Date of referral

Name of referring dental practitioner

Name & address of the dental practice including postcode and telephone number

Patient’s GP details to include name, address and telephone number

Relevant medical history.
Referrals submitted on the CDS form attached will meet these criteria when fully completed.
Referral acceptance criteria
Acceptance criteria for patients with special needs include:
People with a moderate or severe medical disability

People with a moderate or severe physical disability

People with moderate or severe learning disabilities

People with moderate or severe dementia

Adults with mental illness who cannot be treated in primary care

In-patients and patients staying in secure units due to their mental status

People with a group of sensory, medical, physical, emotional, mental, intellectual, social
disabilities that in combination make them unable to access general dental services

Patients where treatment under sedation has been attempted but failed

Patients whose eligibility is uncertain may be accepted subject to a clinical assessment
These criteria exclude adult patients referred for sedation because of anxiety alone i.e. without any
of the other criteria outlined above.
Cont overleaf…
In addition the service accepts children who have:
Dental anomalies that affect the structure and development of the dentition

Dental trauma

Behavioral problems / limited co-operation
This service is provided at: all CDS clinics
Scroll down for the referral form (2 pages)
Referral of
CHILDREN & ADULTS
WITH ADDITIONAL NEEDS
Please write clearly, complete all sections and enclose FP17RN
PRACTICE NAME & ADDRESS
REFERRING DENTIST
Name: ……………………………………
Tel: ………………………………………
Signature: ………………………………
Date: ……………………………………
PATIENT’S GP DETAILS
PATIENT DETAILS
Must be a Bedfordshire or Luton GP
Mr
Mrs
Ms
Miss
Master
GP Name: ……………….………………….
Name: ………………………………………………
Practice Name: ……..………………………
Date of Birth: ………………………………………
Practice Address: ……..…………………..
Address: …………………………………………..
……………………………………………….
………………………………………………………
……………………………………………….
Postcode: …………………………………………
Postcode: ……………..……………………
Tel (preferred): …………………………………….
Practice tel: …………………………………
Tel (alternative): …………………………………….
RELEVANT MEDICAL HISTORY
For use from 1 Nov 2012
RELEVANT DENTAL HISTORY
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REASON FOR REFERRAL AND TREATMENT REQUESTED
Please include details of any dental care you are currently undertaking on this patient, not
requiring CDS involvement
ADDITIONAL INFORMATION
Reason referral indicated:
Poor cooperation / anxiety

Complex medical history 
Physical disability/ access

Domiciliary Visits

Mental health / dementia

Learning disabilities

May require sedation or general anaesthesia? Yes/No
Is the referral for:
This course of treatment 
Long term care 
Would you like to be informed if the treatment plan needs to be changed?
Yes/No
Patient’s preferred CDS clinic ……….……………………………………..
Radiograph(s) enclosed 
If paper copies of digital radiographs are sent, these must be of adequate quality to allow proper radiographic
assessment of the case. Digital radiographs can be sent electronically to cds.referrals@nhs.net but please be
aware that any message sent with patient identifiable information should only be sent from an NHS.net email.
(If images are being sent by email please ensure that the image is sent in a standard image format, or
please contact us if any specific viewer software is required.)
Please send referrals to: 
Checklist
All sections completed?

Beds/ Luton GP?

Xrays enclosed?

FP17RN enclosed?

For use from 1 Nov 2012
The Referrals Administrator
Community Dental Services CIC
Bedford Heights
Manton Lane
Bedford MK41 7PH
Or from a secure encrypted NHS.net email to:
cds.referrals@nhs.net
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