Facebook-f Instagram
new patient registration form

Sedation Referrals

An explanation of what we offer and who can be referred.

Who can be referred for sedation?

There are two options when referring a patient for sedation. You can refer a patient through our NHS service or privately. We have a list of criteria to determine who is suitable for a sedation referral. You can find this list of criteria, (which you can download or print), at the bottom of this page.

How to refer:

Referrals to Cudworth Dental Surgery have never been simpler. Our referral forms are available to download via this website, (see below). Referrals can be emailed to sedation@cudworthdental.co.uk. Alternatively, you can post them to:

Cudworth Sedation Centre
260 Barnsley Road
Cudworth
Barnsley
S72 8SU

How our sedation referral service works

Once a referral has been received and processed, we will contact the patient to schedule a consultation at our surgery.

Should you wish to discuss anything further please contact a member of our dental team on 01226 710380.

Referral Forms

NHS Referral Form
Private Referral Form
Intravenous Sedation
Inhalation Sedation
Patient Criteria Form

NHS Referral for Conscious Sedation

This service is for patients aged 16 and above, who either live in the Barnsley area, or are referred by a dentist in the Barnsley area, who require extractions, fillings and/or periodontal treatment under conscious sedation. For any other patients, please complete a private referral form.

    Patient Details

    Referring Dentist

    Medical History

    Please provide the patients height and weight, and identify any medical conditions which your patients suffers from, and add any additional information below. The following will determine a patients suitability to have intravenous sedation. Most patients who are unsuitable for intravenous sedation can be offered inhalation sedation as a safe alternative.

    Referral Details

    The patient is being referred for...

    Extraction

    R

    L

    Filling (Please include the tooth surfaces for all fillings required)

    R

    L

    Perio Treatment (provide BPE)

    Please indicate the type of sedation that the patient requires

    (Please tick both options if the patient is willing to have inhalation if they are deemed unsuitable for intravenous sedation)

    Please indicate the reason why the patient requires treatment under sedation

    Please use this space to provide any other relevant information

    X-rays

    Any referrals without the relevant x-rays will be rejected. We require PAs or an OPG for extraction referrals, and bitewings for restorative referrals as standard. X-rays must be of diagnostic quality and taken within a reasonable time frame. Patients who are uncooperative for intra-oral x-rays should be referred to a secondary care setting for an OPG prior to being referred to our service.