Online Referral Form

Referrers can complete this online patient referral form and attach supporting PDFs, images and X-rays.

Relevant Surgeon(Required)

First Available

Dr Geoffrey Findlay
BDSc(Hons), MBBS, FRACDS(OMS) Oral & Maxillofacial Surgeon

Dr Nigel Johnson
BDSc(Hons), MBBS, MPhil (Surgery), FRACDS(OMS) Oral & Maxillofacial Surgeon

Dr Scott Borgna
BDSc (Qld), MSc (Oral Surg.) (LOND.), MDS (OMFS) (ADEL), FADI, FICD Oral & Maxillofacial Surgeon

Dr Jen-Ti (Rachel) Hsieh
BSc, MBBS(Hons), BOralH, GDipDent, FRACDS(OMS) Oral & Maxillofacial Surgeon

Dr John Arvier OAM
BDSc (Qld), MSc (Oral Surg.) (LOND.), MDS (OMFS) (ADEL), FADI, FICD Oral & Maxillofacial Surgeon

Patient Name(Required)

Date of Birth(Required)

Contact Number(Required)

Address(Required)

Suburb(Required)

State(Required)

Postcode(Required)

Reason for Referral(Required)

Medical / Dental History(Required)

Referring Practitioner(Required)

Address(Required)

Contact Number(Required)

Provider Number(Required)

Signature

Date

Supporting Attachments

Max. file size: 50 MB.

Please upload PDFs, images and Xrays.