Online Referrals

Health practitioners, you may use our Online Referral Form below to refer patients to see us. If you would prefer a referral pad be sent to you, please contact our rooms on 9885 5241 and we’d be happy to assist you.

Online Referral Form

Patient Details



Reason for Referral
Oral mucosal lesion/swellingTemporomandibular disorderFacial painIntraoral painAltered oral sensationUnexplainable toothacheAssessment of radiographXerostomiaOther

Attached Files
Please upload any relevant clinical photos or radiographs below. If larger then 5MB per file, please instead email to receptiongic@gmail.com



Clinical Details

Referring Clinician's Details