Referring Dentists

Referring Dentists

    Please Indicate

    Treatment Needed

    Tooth Number

    Crack Tooth/ Pain Assessment

    Root Canal Treatment

    Root Canal Retreatment

    Post Core Composite


    X-Ray attached (1 X-Ray attachment allowed)

    not more than 5mb

    (For referring dentist, a copy of the online referral will be sent via the clinic email provided)