Pediatric Dentist to ENT Referral Form

Streamline Pediatric ENT Referrals with Paperform

When a pediatric dentist identifies potential airway concerns, sleep-disordered breathing, or other conditions requiring ENT evaluation, clear communication between providers is essential for optimal patient outcomes. This Pediatric Dentist to ENT Referral Form template makes it simple to document critical clinical findings and ensure seamless care coordination.

Why Pediatric Dentists Need Efficient ENT Referral Forms

Pediatric dentists are often the first healthcare providers to recognize signs of airway obstruction, sleep apnea, enlarged tonsils, or breathing difficulties in children. From observing mouth breathing and crowded airways during routine exams to noticing behavioral changes that may stem from poor sleep quality, dentists play a vital role in early identification.

However, traditional referral processes—faxing handwritten notes, scanning forms, or sending incomplete information—can delay care and lead to miscommunication. A digital, comprehensive referral form ensures that ENT specialists receive all the clinical details they need upfront, reducing back-and-forth calls and helping children get timely treatment.

What This Template Includes

This template captures everything a pediatric ENT specialist needs to evaluate a referred patient:

• Patient and referring provider information with complete contact details
• Chief complaint and reason for referral with specific concerns
• Airway assessment including palate morphology, tongue position, and oral breathing patterns
• Sleep-disordered breathing symptoms such as snoring, apnea episodes, restless sleep, and daytime fatigue
• Tonsil and adenoid grading using standardized clinical scales
• Behavioral and developmental observations including ADHD symptoms, learning difficulties, and growth concerns
• Clinical findings from dental examinations that may indicate airway issues
• Supporting documentation upload for radiographs, photos, or previous records
• Urgency level to help ENT offices prioritize scheduling

By capturing this level of detail in an organized, professional format, you ensure that every referral is complete and actionable.

Built for Pediatric Dental Practices and ENT Specialists

Whether you're a solo pediatric dentist, part of a group practice, or working in a multidisciplinary clinic, this form template helps you:

• Standardize your referral process so every ENT referral includes consistent, comprehensive information
• Save time by eliminating handwritten forms and redundant phone calls
• Improve patient outcomes through faster, more accurate communication between providers
• Strengthen professional relationships with ENT specialists who appreciate thorough, organized referrals
• Maintain better records with automatic submission tracking and digital documentation

For ENT practices receiving referrals, this template ensures you get complete clinical context before the first appointment, allowing for better preparation and more efficient consultations.

Customize and Automate with Paperform

This template is fully customizable using Paperform's intuitive editor. You can add your practice logo and branding, adjust clinical questions to match your protocols, include practice-specific fields, or modify terminology to align with your referral network's preferences.

Once a referral is submitted, you can automatically send confirmation emails to both the referring dentist and the patient's family, create tasks in your practice management system, or use Stepper (stepper.io) workflows to route referrals to the appropriate ENT specialist based on urgency level or specific concerns. You can also integrate with your CRM, Google Sheets, or other tools to keep referral data organized and accessible.

Who This Template Is For

This referral form is designed for:

• Pediatric dentists identifying airway concerns, sleep-disordered breathing, or craniofacial issues requiring ENT evaluation
• General dentists treating pediatric patients who observe signs of tonsillar hypertrophy or breathing difficulties
• Orthodontists working with children who show signs of airway obstruction or mouth breathing
• Pediatric ENT specialists who want to provide referring dentists with a standardized intake format
• Multidisciplinary pediatric clinics coordinating care between dental and ENT providers

Professional, Secure, and Compliant

Paperform is trusted by healthcare practices worldwide and is SOC 2 Type II certified and GDPR compliant, ensuring that patient information is handled with the highest security standards. While Paperform is not HIPAA compliant, many healthcare providers use it for administrative and non-PHI referral coordination.

You can control access with password protection, require authentication, set expiration dates for referral forms, and export data securely. All submissions are stored safely and can be accessed anytime from your Paperform dashboard.

Get Started in Minutes

With over 30,000 designer templates and an intuitive doc-style editor, Paperform makes it easy to launch professional healthcare forms without any coding or design skills. Start with this template, customize it to match your practice's needs, and begin sending organized, comprehensive ENT referrals that improve care coordination and patient outcomes.

Whether you're referring one patient per month or dozens per week, this template helps you maintain clinical excellence while saving time on administrative tasks—so you can focus on what matters most: your patients' health and wellbeing.