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Refer A Patient

REFER A PATIENT

Referring a patient to Perio Care? You've come to the right place!

All general enquiries and referrals are kept strictly confidential.

At Perio Care, we aim to make the referral process easy for you. Simply fill out our Patient Referral Form and send it to our team, or alternatively, complete the form below.

If you have any questions about sending through a referral please call our team on 07 3350 4344.

Have a question or need some advice?

Referral Form

Patient's Name*

Patient's Email

Patient's Address

Patient's Phone Number*

Patient's Date of Birth*

Day

Month

Year

Select Preferred Location*

Chermside

Spring Hill

Preferred Periodontist*

First Available

Dr Rachel Garraway (Chermside)

Dr Richard Grant-Thomson (Chermside, Spring Hill)

Dr Peter Chen (Chermside)

Dr Amro Farag (Chermside, Spring Hill)

Dr Kaye Kendall (Spring Hill)

Reason for Referral*

Upload X Ray Image(s)

Add up to 10 files

Date(s) of radiograph acquisition (if known and not documented on the image files)

Referring Dentist / Practitioner Details*

Practice Name*

Practitioner or Practice Email*

Would you like a copy of this referral emailed to you? *

Yes

Have you referred to our practice before? *

Yes

How would you like the report sent back to you?*

Via Email

Via Post

Via MediRef (Secure Messaging Service)

Have a question? Call or Email us today

Brisbane Implant Dentistry & Perio Care

800 Gympie Road

Chermside QLD 4032

Brisbane Implant Dentistry & Perio Care

Level 6, 200 Creek Street

Spring Hill QLD 4000

Phone:

Chermside - (07) 3350 4344

Spring Hill - (07) 2142 1774

Email:

admin@periocare.com.au

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