Parramatta Dental Specialists Referral Form

Refer a Patient

Thank you for considering us for your patient’s prosthodontic care. We are committed to providing the highest standard of specialist treatment and ensuring your patient feels supported every step of the way.

To refer a patient, please complete the referral form or contact us directly on 02-9633 24 23 to speak with Dr Zoe Potres (Prosthodontist).

REFERRAL FORM

PATIENT'S DETAILS

Name *

First

Last *

Last

Address

Date of Birth

Reason For Referral

Implant Assessment/Treatment

Surgery/Implant Placement only

Implant Placement & Restoration

Management of Worn Dentition

Cosmetic Management and Assessment

Full Mouth Rehabilitation

Other ReasonOther Reason

REFERRER DETAILS

Name

First

Last

Address

Email *

Phone

File Upload

Maximum file size: 516MB

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Parramatta Dental Specialists Referral Form

Refer a Patient

PATIENT'S DETAILS

REFERRER DETAILS

Our Services