At Perth Prosthodontics, we will endeavour to work closely with referring dental practitioners, offering our expertise from diagnosis and treatment planning through to the execution of prosthodontic treatment in all aspects of reconstructive, aesthetic and implant dentistry.

Please fill out the online referral form or access its pdf version “hyperlink” and submit via post, email or fax. Referral pads can also be provided to your practice upon request.

Perth Prosthodontics
(Southbank Central Centre)
Suite 3/38 Meadowvale Ave,
South Perth, WA 6151

T: (08) 9368 0888
F: (08) 9368 0988
E: info@perthpros.com.au

We will contact the patient to arrange an appointment and keep you informed of their progress at every stage.

Download the PDF version of this referral form  (462KB).

 

  • Patient Details

  • Date Format: DD dash MM dash YYYY

  • Reason for Referral

  • Clinical Details

  • Preferred Clinician

  • Referring Dentist

  • Note: A copy of the completed referral will automatically be emailed to you upon submission of this form
  • Date Format: MM slash DD slash YYYY
  • Drop files here or
    • Note: All fields are compulsory

    Got some questions?

    Get in touch with the Perth Prosthodontics Team today!

    Preferred Call Back
    Preferred Call Back