Referrals – Perio Partners – Specialist Periodontics and Implants Melbourne

Referral

Please indicate if you would like our team to contact your patient to arrange the initial consultation or leave it up to your patient to contact us. Please let us know if the referral is urgent, we will do our best to accomodate your patient as soon as possible.

Online referral

Please submit the online referral form and include any relevant radiographs and images. Please indicate if you would like our team to contact your patient or let us know if your patient will contact us for an appointment.

First Name

Last Name

Phone Number

Address

Date of birth

Services (please select below)

Periodontist

Reason for Visit

Implant details

Refer for restoration

Clinical details and relevant case history

Oral Medicine Specialist

Reason for Visit

Clinical details and relevant case history

Select option for patient contact

Referring Clinician Details

Name with title (Prof. Dr. Mr. Ms.)

Full name

Phone number

Email address of referring dentist

Practice address

Attach relevant documents (up to 20 images)

Online referral

First Name

Last Name

Phone Number

Address

Date of birth

Services (please select below)

Periodontist

Reason for Visit

Implant details

Refer for restoration

Clinical details and relevant case history

Oral Medicine Specialist

Reason for Visit

Clinical details and relevant case history

Select option for patient contact

Referring Clinician Details

Name with title (Prof. Dr. Mr. Ms.)

Full name

Phone number

Email address of referring dentist

Practice address

Attach relevant documents (up to 20 images)

Self-referrals

If you would like to consult with a specialist without a prior referral, please contact the practice by phone to speak with one of our receptionists.

Other resources and information

Australian and New Zealand Academy of Periodontists: https://www.perioinfo.org/

American Academy of Periodontics: https://www.perio.org/

European Federation of Periodontology: https://www.efp.org/