For GPs, dentists and specialists

Referrals

Refer a patient for implant assessment, CEREC restorations, oral surgery, root canal treatment, laser or prosthetic care. Urgent? Call (08) 9330 7115.

Call (08) 9330 7115

Please don’t email clinical information or attachments. Email isn’t a secure way to send health information. Use this form when it’s live, or call us and we’ll arrange a secure method.

Online referrals are being set up. Until the secure form is connected, nothing you type here is sent; please call (08) 9330 7115 to refer a patient.

1. Referring practitioner

Your name

Practice name

AHPRA registration number 3 letters and 10 digits, for example MED0001234567

Practice phone

Practice email (optional)

2. Patient

Patient full name

Patient date of birth

Patient phone

3. Referral

Urgency

Reason for referral

Relevant history and clinical notes (optional)Medical history, medicines and allergies relevant to dental care, and what you’d like us to assess.

Attachments: X-rays, letters, scans

Secure, encrypted file upload will be available here when online forms are switched on. Until then, please don’t email files; we’ll tell you how to send them securely when we call.

The patient has agreed to this referral and to us contacting them to book.

Submitted only through our secure Zoho form. Personal and clinical fields are encrypted. Privacy policy

Your next step

Request an appointment online, call or text our team.

Request an appointment (08) 9330 7115 Text 0480 012 101