Community Dental Services: Dentist Referral

We promise to work ethically with you and return your patient back to you. We will involve and inform you of your patient’s treatment every step of the way.

We will support you and your dental clinic, mentor and help you develop your skills & CDP.

We will endeavour to treat your patients with the utmost care and diligence.

Simply fill in the below form to refer a patient and one of our dentists will contact you to arrange further details.

    Referring Practitioner





    Patient Details







    Private Health Insurance
    YesNo


    Referral Details

    Referring
    ImplantologyOrthodonticsEndodonticsCosmetic DentistryProsthodonticsHygienePeriodonticsPaediatric DentistryOral SurgeryIV SedationFacial TreatmentsInvisalignOther


    I would like to be present during the consultation/treatment
    YesNo

    I would like the dentist to contact me to discuss the case
    YesNo


    Has the patient been given an estimate of our fees?
    YesNo


    Documents

    Upload any notes or X-rays here:

    Simply fill in the below form to refer a patient and one of our dentists will contact you to arrange further details.

      Referring Practitioner





      Patient Details







      (Parallel to occlusal plane unless requested otherwise)
      CT MaxillaCT MandibleCT of both jawsPlease tick if you would like CT Maxilla to show 20+mm maxillary sinus (e.g. prior to sinus lift)

      YesNo



      Patient’s will be requested to make payment at the Scan appointment.
      Please indicate if you prefer the referring practitioner to be invoiced