For Dentists

Are You A Dentist?

If you’ve got a patient you’d like to refer for orthodontic treatment at our clinic in Frankston, please fill in this form and one of our orthodontists will get back to you as soon as possible.

Dentist Details

Dentist Name*

Dentist Email
Dentist Telephone

Dentist Address

Patient Details

Patient Name*

Patient Email

Patient Telephone

Patient Date of Birth

Patient Address


Treatment details

Reason for referral

Treatment Request

Any other comments:

Attach your patient xrays, images, and reference material files here


Lateral Cephalogram

Other If Any

Frankston Clinic:

46 Karingal Drive,
Frankston, VIC 3199

Dandenong Clinic:

70 Stud Road,
Dandenong, VIC 3175

Clinic Hours: