Dentist to Periodontist Referral Form

Streamline Periodontal Referrals with Professional Digital Forms

When referring patients to a periodontist, clear and comprehensive communication is essential for optimal treatment outcomes. This dentist to periodontist referral form template provides a structured way to document periodontal conditions, pocket depths, bone loss measurements, and patient hygiene compliance—all in one professional digital form.

Built with Paperform, this template eliminates handwritten referral slips and faxed charts that can be difficult to read or easily lost. Instead, you get a clean, branded form that captures all the clinical details your periodontal colleagues need to provide excellent care from the first appointment.

Perfect for General Dentists and Dental Practices

Whether you're a solo practitioner or part of a multi-location practice, this referral form helps you maintain professional relationships with specialist partners while ensuring continuity of care. Document periodontal pocket depths, furcation involvement, mobility grades, radiographic bone loss, and patient compliance history in a consistent format that periodontists can quickly review and act upon.

The form includes conditional logic to capture relevant details based on the reason for referral—whether it's advanced periodontitis, pre-prosthetic surgery, implant placement evaluation, or regenerative procedures. This means you only collect the information that matters for each specific case.

Automate Your Referral Workflow

Once submitted, this form can automatically trigger your next steps using Stepper (stepper.io), Paperform's AI-native workflow builder. Send the referral details directly to the periodontist's email or practice management system, update your internal patient records, schedule a follow-up reminder to check on treatment progress, and maintain a searchable database of all referrals.

You can also generate PDF summaries of each referral for patient charts or insurance documentation, and set up notifications when the periodontist confirms receipt or provides feedback on the case.

HIPAA-Conscious Design for Healthcare Professionals

While Paperform is not HIPAA compliant, this template is designed with healthcare data sensitivity in mind. You can use it for internal referral workflows, preliminary consultations, or in combination with your existing HIPAA-compliant systems through Paperform's integration capabilities and webhooks.

For dental practices looking to modernize patient referrals, improve specialist communication, and reduce administrative overhead, this Paperform template offers a practical, no-code solution that fits seamlessly into your existing workflow—no IT department required.