Sedation Referral Form
Dear Referring Dentist,
Thank you for considering our service for patients requiring dental extractions under intravenous (IV) sedation.
Please read the following referral criteria carefully before submitting a referral. To ensure patient safety and appropriate use of our service, we can only accept referrals that meet all of the criteria outlined below.
Referral Acceptance Criteria
Patients referred for IV sedation must:
- Be aged 18 years or over.
- Be classified as ASA I or ASA II.
- Not use recreational drugs.
- Have been fully examined and treatment planned by the referring dentist prior to referral.
- Require Level 1 dental extractions only under IV sedation.
Scope of Treatment
Our service is specifically limited to the provision of Level 1 dental extractions under single drug IV sedation. We are unable to undertake any restorative treatment, including restorations, crowns or endodontics, as part of the referral.
Please ensure that the proposed extractions have been clearly identified and that all relevant clinical information, radiographs, medical history, and treatment planning details are included with the referral.
Important Information for Patients and Referring Dentists
Please note that referrals are accepted on a one-off treatment basis only. We do not provide ongoing dental care or accept referred patients for continuing treatment.
Acceptance of a referral for extraction under IV sedation does not constitute acceptance of the patient as a new NHS patient at our practice, nor does it guarantee access to future NHS or private dental treatment through our service.
Responsibility for the patient’s ongoing dental care, including any further treatment required following the extraction, remains with the referring dentist, unless alternative arrangements have been made.
Our waiting times will vary depending on the number of referrals being processed. If a patient wishes to be seen quickly please consider a private referral. Please note we are able to accept some restorative treatment through private referrals including simple restorations and single root endodontics.
Referrals that do not meet the above criteria may be declined.
Thank you for your cooperation and for helping us ensure that referrals are appropriate for the service we provide. If you have any queries regarding referral suitability, please contact us before submitting the referral.
Kind regards,
The Sedation Team
Sharrow Dental Care
