We thank you for entrusting our care for your patient.

Click on the appropriate tab below for your referral.

An upload link will open after referral is submitted to allow xrays, photos and investigations to be uploaded.

NEWCASTLE AND HUNTER REFERRAL

PATIENT DETAILS

PATIENT NAME

Date of Birth

Phone number

Address

REFERRER DETAILS

Referrer Name

Provider number

Phone number

Practice Name or Address

Practice Email

REASON FOR REFERRAL

Comments

Any xrays, photos or investigations to upload?

A Dropbox upload link will open following submission of form. Please save the file in patient's name.

Yes

PORT MACQUARIE AND TAREE REFERRAL

PATIENT DETAILS

First Name

Last Name

Date of Birth

Phone Number

Address

REFERRER DETAILS

First Name

Last Name

Provider number

Phone number

Practice Name or Address

Practice Email

REASON FOR REFERRAL

Comments

Or download the referral form and email back to us

Download pdf referral form

Need referral pads or business cards sent to you?

Please submit the form below and we will send these to help you with the referral process.

Practice or Clinician Name

Phone number

Mailing address

What you require

Please select any options. Please indicate the number of referral pads in the comments section

Referral Pads

Business Cards

Other

Comments

We thank you for entrusting our care for your patient.

Click on the appropriate tab below for your referral.

An upload link will open after referral is submitted to allow xrays, photos and investigations to be uploaded.

Or download the referral form and email back to us

Need referral pads or business cards sent to you?

Please submit the form below and we will send these to help you with the referral process.

OMS SPECIALISTS

High quality specialist care in Oral and Maxillofacial surgery

Referrals

We thank you for entrusting our care for your patient.

Click on the appropriate tab below for your referral.

An upload link will open after referral is submitted to allow xrays, photos and investigations to be uploaded.

Or download the referral form and email back to us

Need referral pads or business cards sent to you?

Please submit the form below and we will send these to help you with the referral process.

OMS SPECIALISTS

High quality specialist care in Oral and Maxillofacial surgery