COVID PRESS | Dental Referrals

Your Name*
Position held*
Tell us who you are?
Practice Name
Name of nominated PRESS Manager*

This the person who we will communicate with regarding any issues on PRESS and whom we will send update information to. This will be in addition to the named individual above.
Email address of nominated PRESS Manager*
Email address for logging into to system*

This can be the same as above, this is the email you will use for your username and the referral application will send information here. This email MUST be different from the one that you use to send referrals and unique to this login. Notifications are sent to this email address.

Practice Address
Street Address Address Line 2 City County Postcode
Practice V Code

Your NHS organisation number (If you do not know this please leave blank)
Phone
Practice Email address - Patient use

This is the email address that will be added to your PRESS portal for patient and dentist use.

Provider Type*
- Orthodontic Provider
- Oral Surgery / Sedation Provider
- Restorative Provider
- Special Care Dentistry
- Peadiatric Dentistry
- Other - or multiple service types
Tell us what kind of provider you are
Please let is know what your service type is
DocMail Service
We can print and post letters for you to patients automatically. These can include partial appointment letters, consent forms and other information. There is a charge for this service, would you like to know more about this? There is no obligation to use this system and requesting information does not commit you. This service is not active - this question is purely to gauge interest
- Yes please - email me with information
- No thanks - we will print and post our own letters manually

Referral Criteria & Service Eligibility
I.e. only patients whose GP postcode is within Bolton
If you have specific service criteria, please let us know. This might be based on geography, GP postcode, age, etc
Reasons for rejecting patients
Tell us the common reasons that you return referrals?
Travel Information
Tell us how patients will find you, including information on parking.
Pratice or service information leaflet
Drop files here or

Max. file size: 256 MB.
If you have a practice information leaflet or other documentation that will be useful to patients, please upload it here.

Clinicians
i.e Sarah Smith - 4452345
Please let us know the name and GDC number of clinicians providing the service.
Anything else?
If there is anything else that we haven't asked about, please tell us here!

Phone Number 1

Please provide at least one phone number, including dialling code, to receive your login pass code (a new code is needed each time you login). PLEASE NOTE: THE SYSTEM CANNOT CALL 0845 OR 0844 NUMBERS OR NUMBERS THAT UTILISE AN ANSWERPHONE MESSAGE BEFORE THE CALL IS CONNECTED OR CALL HANDLING (I.E. PRESS 1 FOR... ETC) We would generally recommend mobile numbers as the practice phone is likely to be busy). You can enter up to five numbers here and you can add more later if you need them.
Phone Number 2
Phone Number 3
Phone Number 4
Phone Number 5

Signature*
We are required to enter a simple Data Processing Agreement with you in order to send referrals to you and comply with the upcoming GDPR regulations. Once signed we will email a copy of the completed document to you.
You can view a sample version of the Data Processing Agreement here. This will be completed, signed and emailed to you.

Useful links