Dental Emergency Referral Form

Refer Dental Emergencies

Welcome to our dedicated referral service for emergency doctors. We understand the urgency and discomfort of dental emergencies. If your patient is suffering from dental trauma, toothache, or an abscess, please provide their details through our referral form. We’re committed to offering them relief with the utmost care and compassion. You can also book online, chat with us directly from our website or call us on (07) 3343 4869 if urgent dental care is required.

Urgent Dental Care in Brisbane for Toothache and Dental Trauma

Dental Emergency Referral Form

Patient Details

Name(Required)

First Last

Date of Birth(Required)

Mobile(Required)

Referring Doctor Details

Name(Required)

First Last

Phone

Brief description of the reason for the appointment

Radiographs or Photos maximum 15 MB

Drop files here or

Max. file size: 15 MB.

Phone

This field is for validation purposes and should be left unchanged.