Referral Form

Please click here to download our dentists referral form.

Alternatively, feel free to complete our online form below:

• Patient's details

• Name:
• Address:
• Telephone (Work):
• Telephone (Home):
• Telephone (Mobile):
• Email address:

• Referral information

• Urgent: Yes No
• Patient being referred for: Periodontics Implants
• If Implants please specify: Extraction & Socket Preservation Implant Placement Only Implant Placement & Restoration Sinus Bone Graft Block Bone Graft Other - Please Specify
• Additional Relevant Information:
• Relevant Medical History:
• Relevant Dental History:
• Import Jpeg File:
• Information to follow:
• Radiographs
• Photographs
• Letter

• Referring Dentist Details

• Dentist Name:
• Dentist Telephone:
• Dentist Email:
• Dentist Address:
•  

Make an appointment

I have, and will continue to recommend Chong to my friends and anyone who might need help and guidance with their dental needs.

It is not difficult to understand how Chong has such an excellent register of loyal patients.

I have always been very impressed, not only with his technical expertise and professionalism, but also his ability to put me at ease.

Success was due to your surgical skills and the confidence you gave me at all times enabled me to do it. I feel they are my own natural teeth.

He has helped and advised me on the options at every stage of my treatments and I much admire his professionalism and honesty.

I was reassured throughout by Chong's careful preparation and efficient approach..