Dear doctor, please contact us to get a pad mailed to you

Online PDF Referral form – GT Periodontics – Sydney Office [PDF] | Newcastle Office [PDF]

Online Referral Form

For multiple or large CBCT files, please include and use our wetransfer link

    Introducing*

    Patient Contact number*

    Patient Contact number 2


    Regarding*:

    Photos or attachments (5MB each file)


    Do you want to send a DICOM CBCT ? - Use our wetransfer link


    Patient History / Reason for referral

    Referred by:

    Dr Name*

    Dr Email*

    Dr Phone*

    Hit send then wait a moment for your uploads to complete. You will be notified when sent.

    Do you want to send a DICOM CBCT ? – Use our wetransfer link

    Cancellations

    Please advise us if you are unable to attend your appointment, as late cancellation and non-attendance fees may apply