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)