Dental Professionals 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.

Alternatively 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

Emailed

Upload Files (if multiple files please create zip file)

Clinical Notes / Medical History

Keep up to date us and sign up to our mailing list.