For doctors

Referral for surgical opinion / management

If you would like to refer a patient for a surgical opinion or management, please complete our referral form or download and forward it to us. We will contact your patient to make an appointment.

Patient details

Title
Given Name
Surname
Date of Birth
Home Address
Suburb
Postcode
Phone Number

For consultation and treatment regarding

Wisdom Teeth Removal
Tooth Extraction – including the surgical removal of impacted and infected teeth
Dental Implants
Corrective Jaw Surgery (Orthognathic Surgery)
Facial Injury
Pathology – mouth / jaws
Please provide any further information or medical history relevant to your referral:
Attach OPG / X-ray / Photo (optional):
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Radiographs

Already taken and available online at:
Please take appropriate imaging in your rooms

To book an appointment, please call us on 03 5229 3200

Referred By:

Doctor's Name
Practice / Clinic Name
Provider Number
Address
Suburb
Postcode
Phone Number
Email Address

Authorisation:

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Date

Get in touch

Please fill out the form below to book a consultation at Precision OMS’s Geelong offices.

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