Aim &objectives A clinical audit was carried out to assess suitability of orthodontic referrals at Kings College Hospital Orthodontic Department with the objective to investigate the reasons and seek solutions to inappropriate orthodontic referrals.Design and setting Prospective audits of consecutive new patient referrals to the King's College Hospital Orthodontic department diagnostic teaching clinics.Methodology Two hundred and twenty-eight patients referred to the orthodontic diagnostic teaching clinics over a 5-month period were assessed. Data were collected using a questionnaire, completed by the undergraduate dental student and checked by the supervising clinical teacher. A second audit cycle was carried using the same methods after implementation of an action plan devised for referral guidelines and pathway to be sent back to the referring practitioner.Results At the initial audit cycle, 37.2% of patients met the standards, dropping to 33.3% at second audit cycle demonstrating high levels of inappropriate referrals. Our results showed: poor use of IOTN, patients presenting with IOTN scores too low for treatment, poor oral hygiene and caries; patients presenting too early for treatment, adult patients; and incorrect referral pathway implementation. Targeted education of referring practitioners via referral guidelines were found ineffective. We suggest that other methods to improve the quality of referrals are required, such as proformas and improving education among the profession.