02 9601 5111
02 9601 5111

Referral from Dr Tan (Attractive Orthodontics) to Dr Oteng-Boateng

Specialist Oral & Maxillofacial Surgery Phone 02 9601 5111
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PATIENT DETAILS

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Patient's Name
Date of Birth

REFERRED FOR

Reason for referral:
Please include tooth number and location
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Upload radiographs and clinical photos. Alternatively you can sned to info@oralsurgery.sydney
Radiograph / Radiology
Anaesthetic Choice
Nitrous oxide and intravenous sedation only available at Liverpool and Camden practices.

REFERRING CLINICIAN

A copy of this referral will automatically be sent to Dr Oteng-Boateng, Attractive Orthodontics and the patient (if their email address has been entered). If you would like another copy sent elsewhere please enter the email address above.