For your convenience, you can refer patients electronically via our online form.
Fields marked with an asterisk (*) are required.
Patient Name *
Date of Birth *
Parent or Guardian *
Urgent (appointment today)Next available appointment
Clinical Details *
Name of Practice *
Referring Dentist *
Date of Referral *
Objectives of Referral
Opinion, management of the above condition and provision of ongoing careOpinion, management of the above condition with the patient returned to you for ongoing care
11/1932-1974 Logan Rd,
Upper Mt Gravatt,
P: (07) 3343 4869 F: (07) 4243 4869