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    Dental Referrals

    We accept referrals and thank the support of local dentists, oral health therapists, allied health and medical professionals in Townsville who have asked us to participate in their patients’ care.

    Trust that when have completed treatment, a paediatric dental treatment report will be sent back to each referring practice, and with parental advice to return and regularly see their primary dental providers.

    Our referral form is available for download on this link.

    Alternative kindly fill out the form below.

    Referral Form

    Referring Dentist and Practice

    Referring Dentist
    Name of Practice
    Address of Dental Surgery
    Phone Number
    Email Address

    Patient Details

    Name
    Date of Birth
    Name of Parent/Guardian
    Phone Number
    Email Address

    Reason for Referral

    Select reason/s *
    Consultation
    Non-pharmacologic Behaviour Management
    Treatment under Relative Analgesia
    Complex Treatment under General Anaesthetic
    Radiographs enclosed *
    Yes
    No
    Emailed
    Upload Files (if multiple files please create zip file)
    Clinical Notes / Medical History

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    CTA