02 9488 7455 Suite 2, 1335 Pacific Highway
Turramurra NSW 2074

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Doctor Referrals

We invite you to use our online referral form below; alternatively, you and fax/scan our referral form HERE

Please note, this form should be used by referring dentists or medical practitioners only

Patient details
Patient Name*
Email*
Phone (Home)*
Phone (Work)*
Mobile*
Date of Birth
Doctor details
Referring Doctor*
Referrer Phone Number*
Provider Number*
- Please phone me to discuss this case
Treatment Details
Referral Request
- Orthodontic -Dr Kamini Titus
- Prosthodontic -Dr Anthony Au
Attach your patient xrays, images, and reference material files here
File 1
Accepted file types: jpg, gif, png, pdf, doc, docx.
File 2
Accepted file types: jpg, gif, png, pdf, doc, docx.
File 3
Accepted file types: jpg, gif, png, pdf, doc, docx.
File 4
Accepted file types: jpg, gif, png, pdf, doc, docx.
File 5
Accepted file types: jpg, gif, png, pdf, doc, docx.
File 6
Accepted file types: jpg, gif, png, pdf, doc, docx.
Email
This field is for validation purposes and should be left unchanged.

Our team is happy to answer any dental questions you may have.

Make an Enquiry

Got any questions? Please don’t hesitate to get in contact with us

Contact Details

Phone 02 9488 7455
Fax 02 9488 9988
Email admin@dentalspecialists.com.au
Address Suite 2, 1335 Pacific Highway
Turramurra NSW 2074
Hours

Monday to Friday 8am - 6pm

Saturday 10am - 4pm