Refer A Patient

    Patient Details

    Full Name*

    Date of Birth*

    Phone Number*

    Referral Type*
    Sleep / SnoringNMD / TMD / Chronic PainOrthodonticsFull Mouth or Rehabilitative DentistryAll on 4

    Any further details?

    Please upload any supported documentation (x-rays, sleep studies, clinical notes etc)

    Practitioner Details

    Your Name*

    Your Practice*

    Your Email*

    Refer a patient to Dr Anne-Maree Cole at James Street Dentists
    Many of our patients are referred to us for management of TMD, chronic pain, sleep apnoea, orthodontics, full mouth rehabilitations, All on 4 and Myofunctional Therapy. We welcome your referrals, just simply fill out the online form!

    Refer Patient to James Street Dentists (Aesthetic Excellence)

    Complete the referral form with the required information. Ask the patient to call us to arrange a consultation at their convenience.

    Consultation & Treatment Plan

    We will have a consultation to assess and discuss possible treatment options.

    Treatment & Reports

    If the patient would like to go ahead with our care then we will treat the patient and update you via reports on their progress. If the referral is from a dentist, the patients will continue to see their referring dentist for the general and preventative dental care.