Online Referral Form

A specialist clinic in the heart of Sydney CBD

Online Form

Sydney Periodontics and Implant Centre thanks you for your referral and the opportunity to work with you.

We appreciate the trust and confidence you place in us when you refer your patients. Sydney Periodontics and Implant Centre goal is to achieve a seamless transition, so the patients feel like our surgery is an extension of your surgery. To help us accomplish the goal of achieving a seamless transition we have compiled a checklist when referring patients to us.

Online Referral Form
  • The more information we have about the referral the better. Please include tooth numbers and or quadrants associated with your patient’s needs.
  • Please advise on treatment you have completed and what you would like us to do in the future. This will enable us to reinforce your recommendations and be consistent in our treatment planning.
  • Please advise patients that the first appointment will be for a consultation, diagnosis and treatment planning. In most cases treatment will occur at a separate appointment.
  • Current radiographs, especially panoramic (OPG), are very helpful. Please make sure to forward any recent radiographs so we don’t inconvenience patients by taking additional x-rays.
  • Our Online Referral form is available for your convenience.
  • A referral form in pdf format is available for download and print.
    If you have any questions, concerns or suggestions please call us on 02 9221 5499.
  • Online Referral

    Referral Details

  • Patient's Information

  • Attachments (Optional)

    Referral letter or Digital Radiographs to be attached?
    Format: pdf gif jpg jpeg png txt rtf doc docx

    Please upload multiple attachments as a single compressed zip file.

  • Accepted file types: jpg, pdf, png, gif, Max. file size: 5 MB.