Referral Form - General Anesthetic and Other Specific Services - KIDS

Referral to Oral Health & Beyond Collective for General Anaesthetic or Other Dental Services

This form is for professionals to refer to Oral Health & Beyond Collective for purposes of general anaesthetic or other dental services.

For more information please visit our website: https://dentalcarextra.com.au/sedation-dentistry/

Oral Health & Beyond Collective has secured regular theatre bookings with Mackay Specialist Day Hospital (minimum age 2.5 years). Children's dental treatment, surgical extractions, and general dentistry services are provided by Dr Hany Aziz (DEN0000989492), Registered Dentist, and associate dentists.

Any surgical or invasive procedure carries risks. Before proceeding, patients should seek a second opinion from an appropriately qualified health practitioner.

Referrer Details

Referring Clinic*

Practitioner First Name*

Practitioner Surname*

Referring Practitioner Email*

Patient Details

Patient's First Name*

Patient's Last Name*

Patient's Date of Birth*

Parents/Guardians Names (first name & Surname please)

Patient/Parent Mobile - best contact number*

Address*

City

Patient/Parent Email*

Degree of Urgency*

Type of treatment required*

Ankyloglossia Assessment (Oral Restrictions/Lip & Tongue Tie)
General dentistry under general anaesthesia (compliance concerns or extensive treatment)
Third molar extraction under general anaesthesia
Teeth extractions for Pre-Orthodontic
Surgical exposure and attachment of device for orthodontic traction
Other Laser Dentistry (RCT or tissue removal)
Dento-Facial Injectables (TMD)
Snoring Assessment / Laser Treatment
Other Complex Dentistry

Is the patient in immediate pain?

Yes
No

Has the patient had a full exam and clean within the last 6 months?*

Yes
No

Oral Health & Beyond requests that all patients referred to us have completed a full check-up and clean prior to referral if possible. All patients will be returned to you, with clinical report, for ongoing dental care.

If applicable, please upload patient images (photos/x-rays)

Drop files here or

Max. file size: 499 MB.

Note: We suggest that patients have a recent OPG taken or are referred to either QLD X-Ray or QScan for same prior to consultation with us. (if clinically appropriate).

Clinical Notes

Max. file size: 499 MB.

Please upload a copy of relevant clinical notes

Referring Practitioner Comments*

Dr Hany and the Oral Health & Beyond Collective team thank you for entrusting your patients to our care. All patients will require a 30-minute consultation prior to proceeding with any treatment. Please advise the patient they will receive a call from our team within 2 business days for scheduling an appointment, or they can call us directly on 4942 5111. All patients referred will be returned to your practice with a post-operative report for ongoing dental care.

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Mon – Tue	8:30am to 5:00pm
Wed – Thur	8:30am to 4:00pm
Friday	9:00am to 2:00pm