Referral Form

Referral Form

Download/print a referral form

REFERRING SPECIALITY

REFERRING DENTIST'S DDETAILS

Please write your full name below including your GDC number. This will act as an electronic legally binding signature

PATIENT DETAILS

SEDATION REQUIRED

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Our Pledge

  • We aim to build a team with our referring dentists based on trust and respect,both seeking the best outcome for the patient.
  • We will provide your patient with the highest quality specialist dental care, evidence based and clinically proven.
  • We will keep you informed of the progress of your patient throughout the stages of the treatment.
  • We will return the patient back to your care as soon as the referred treatment has been completed, and we will try to do that promptly.
  • We will aim to contribute to your skills through our Study Clubs.

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