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Referral forms request
If you would like to refer a patient to our practice, let us first start by saying thank you – we appreciate your trust in our work, and will ensure your patient is well taken care of and returned to you for on-going care.
If you are a dental or medical professional please complete the referral form and submit it to:
Fax: 02 9810 5349
Email:
Address: Level 1, 45 Rowntree Street, Balmain NSW 2041
and one of our team will contact you to confirm receipt of the details and ask for any other necessary information.
If you would prefer to download this form and send it in, please print this
PDF
Referring Dentist
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Services Required
Implant Surgery Only – Referral back for Restoration
Implant Surgery & Restoration
Bone grafting / Guided Bone Regeneration
Soft Tissue Grafting
Extraction / Socket Preservation Procedures
Cosmetic Consultation
Other (type in text area below)
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