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Our Locations Chatswood and Baulkham Hills

Chatswood (Dr. Willis & Dr. Chou): (02) 8203 8786

Baulkham Hills (Dr. Willis & Dr. Chou): (02) 9158 6637

Sydney CBD (Dr. Willis): (02) 9159 3728

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Home - Dentist Referral Form

referral-form

Dentist Referral Form

1. Who is the referral for?
Doctor
- Dr Patty Chou
- Dr David Willis
- Either
2. Referring Practitioner
Name*
First Last
Email*
Phone*
Date
Date Format: MM slash DD slash YYYY
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
3. Patient Details
Name*
First Last
Email*
Mobile*
DOB
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Preference*
- Patient to call
- Please contact patient
4. Referral Details
Periodontics
- Periodontal Management / Regeneration
- Gingival Graft
- Orthodontic Exposure / Bond
- Fraenectomy / Pericision
- Crown Lengthening
Dental Implants
- Implant Site(s)
Implant Site(s)
- Peri-implantitis
Oral Surgery
- Wisdom Teeth
- Extraction(s)
- Pre-prosthetic Surgery
Do you have Radiographs?
- Yes
- No
How are Radiographs being sent?
- Sent With Patient
- Mailed
- Emailed
Comments / Relevant Medical History

Download a PDF version of our Dentist Referral Form

We welcome new patients whether you’ve been referred by your Dentist or would like to book with us directly.

Please call us for an initial consultation with Dr. Willis or Dr. Chou.

Chatswood (Dr. Willis & Dr. Chou): (02) 8203 8786

Baulkham Hills (Dr. Willis & Dr. Chou): (02) 9158 6637

Sydney CBD (Dr. Willis): (02) 9159 3728

Where To Find Us

Chatswood
(Dr. Willis & Dr. Chou)

(02) 8203 8786
Lemon Grove Shopping Centre
Shop 8, 427 Victoria Avenue
Chatswood, NSW 2067

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Baulkham Hills
(Dr. Willis & Dr. Chou)

(02) 9158 6637
The Hills Private Hospital
Suite 8A, 499 Windsor Road
Baulkham Hills, NSW 2153

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Sydney CBD
(Dr. Willis)

(02) 9159 3728
Macquarie St Day Surgery
Park House level 11/187
Macquarie St, Sydney 2000

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Contact Us

Email:
contact@toothsome.com.au

Business Hours

Monday - Friday:
9am-5pm
Saturday:
by appointment only

Translation

English | 中文

Our Services

Dental Implants
Periodontics
Wisdom Tooth Removal

Suburbs

Baulkham Hills
Chatswood
Artarmon
Beecroft
Bella Vista
Castle Hill
Crows Nest
Darlinghurst
Double Bay
Glenwood
Kellyville
Killara
Lane Cove
Lindfield
North Sydney
Roseville
Sydney CBD

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Call Us Today

Chatswood
(Dr. Willis & Dr. Chou):
(02) 8203 8786

Baulkham Hills
(Dr. Willis & Dr. Chou):
(02) 9158 6637

Sydney CBD
(Dr. Willis):
(02) 9159 3728

English | 中文

Call Us Today

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