Referral

Patient Referral

Thank you for referring your patient to us.
Please complete the form below with as much detail as possible so our team can prepare for your patient’s visit.

Referral Form

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Referring Practitioner Details

Patient Details

Referral Details

Please attach any relevant referral letters, clinical notes, X-rays, or DICOM files to support this referral.
Accepted file types: jpg, png, pdf, Max. file size: 10 MB.

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You may also send an email to office@plazadental.com.au with subject Referral from [Dentists’ Name]



Download our price list

Please enter your mobile number and email address so we can send you the fee price list via SMS and email along with some of our patients’ smile transformations in the next few minutes.

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Plaza-dental-enquiry

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