Referral procedure for Hygienist services

This service provides an option for those practices which do not have a hygienist to give their patients a choice of more extensive non surgical periodontal treatment.

Referral procedure

  • Dentists to complete a referral form which can be printed from the website or to send a referral letter with a written prescription for hygienist treatment (both may be sent or faxed)
  • Types of appointments are as follows and must be specified in the referral form or letter:

Appointment duration 35 minutes


Appointment type 1: B.P.E. 0-2.

  • Review medical history
  • Chart B.P.E.
  • Oral hygiene instruction
  • Full scale and polish

Appointment duration 60 minutes


Appointment type 2: B.P.E. 3+.

  • Review medical history
  • Full periodontal charting, 6 point pocket chart, plaque, bleeding and mobility scores.
  • Oral hygiene instruction
  • Initial non surgical treatment

Further type 1 appointments may be required to complete initial treatment.

3/12 or 6/12 maintenance appointments will be offered to patients.

  • Cleveland CDIC will send written confirmation of receipt of your referral form or letter
  • We will contact your patient, take payment for the appointment and arrange a suitable appointment time.
  • A full written report and copy of charts will be sent to you once treatment is complete