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

Referral Details

ImplantologyOrthodonticsEndodonticsCosmetic DentistryProsthodonticsHygienePeriodonticsPaediatric DentistryOral SurgeryIV SedationFacial TreatmentsInvisalignOther

I would like to be present during the consultation/treatment

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

Has the patient been given an estimate of our fees?


Upload any notes or X-rays here: