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Introduction
At the Boston Center for Oral Health (BCOH), we make it simple and secure for fellow dental and medical professionals to refer patients for advanced specialty care. Whether your patient requires oral surgery, periodontics, orthodontics, or TMJ evaluation, our multi-specialty team is ready to provide comprehensive, patient-centered treatment. This online referral form ensures efficient communication, HIPAA-compliant data sharing, and a seamless transition of care.
We’re proud to partner with referring providers across the Boston area and beyond, helping patients receive expert care in a collaborative and timely manner.
About the Form
The Dental Online Referral Form was created to simplify and streamline the process of referring patients to our multi-specialty dental team at BCOH. Whether you’re a general dentist, physician, or specialist, you can use this secure, HIPAA-compliant form to share essential case information and documentation in just a few clicks.
With specialties ranging from oral surgery to pediatric dentistry, we are committed to delivering high-quality care in collaboration with our referring providers. This form helps us ensure timely communication, proper documentation, and a smooth transition of care.
Form Sections Overview
- Referral Type
Choose from a wide range of specialties including oral surgery, periodontics, endodontics, orthodontics, prosthodontics, pediatric dentistry, TMJ evaluations, implant consultations, or specify another reason. - Patient Information
Includes patient’s full name, date of birth, contact details, address, and any medical alerts or allergies. You may also indicate their preferred method of communication. - Referring Provider Information
Provide your name, practice details, contact information, referral date, and NPI number if applicable. - Reason for Referral / Diagnosis
Briefly describe the case, including the area of concern (e.g., Tooth #14, mandibular quadrant) and urgency level: Routine, Soon, or Urgent. - Clinical Details
Indicate whether radiographs or imaging have been taken, and include relevant imaging dates and findings. Additional clinical notes are welcome. - Supporting Documents Upload
Upload any necessary supporting documentation such as X-rays, chart notes, treatment history, or referral letters in formats like PDF, JPG, PNG, or DOC. - Requested Actions / Notes to Specialist
Use this optional field to specify what kind of evaluation or treatment you’re requesting (e.g., “Evaluate for implant placement,” “TMJ consult”). - Consent
(Optional but recommended) Confirm that the patient has given permission to share their health information for care coordination.
Frequently Asked Questions (FAQ)
Online Referral Form – Multi-Specialty Dental Practice
1. Who is this referral form intended for?
This form is for healthcare professionals—such as general dentists, physicians, orthodontists, and pediatricians—who wish to refer patients to BCOH for specialty dental services in Boston.
2. What types of dental specialties can I refer to?
You can refer patients for oral surgery, periodontics, endodontics, orthodontics, prosthodontics, pediatric dentistry, TMJ evaluation, implant consultation, or other specialized dental needs.
3. Is the referral form secure and HIPAA-compliant?
Yes. The form is encrypted and fully HIPAA-compliant, ensuring the patient’s health information is transmitted securely and privately.
4. What information is required to submit a referral?
We request the patient’s full contact details, medical alerts if applicable, your provider information, reason for referral, clinical notes, and any available radiographs or documents relevant to the case.
5. Can I upload supporting documents with the referral?
Yes. You can attach clinical documents such as radiographs, treatment history, referral letters, or imaging results in PDF, JPG, PNG, or DOC formats.
6. How do I indicate urgency for the referral?
The form allows you to choose between Routine, Soon, or Urgent urgency levels, helping us prioritize your patient accordingly.
7. Will BCOH contact the patient directly?
Yes. Once we receive your referral, our team will reach out to the patient using their preferred contact method to schedule an evaluation.
8. Is patient consent required before submitting this form?
While not mandatory, we recommend obtaining the patient’s permission to share their health information. A checkbox is available on the form to confirm consent for care coordination.