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Referring Dentist

We strive to treat referred patients as our own. With respect, high quality treatment and clear communication to the patient and referring dentist.

For a General Enquiry:

Email:

info@adicentre.com.au

Phone:

(08) 8269 3311

dental instruments

Referral Form

Download PDF Form Here

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

Patient Information:

DD slash MM slash YYYY
Max. file size: 64 MB.

If you have Radiographs currently available, please upload them below:

Fun Fact:

For our young patients (12 - 17 yoa), we are currently offering Preventive Services for just the Rebate from your Private Health Fund or Medicare.