Referral to Oral Health & Beyond Collective for General Anesthetic or other Specialised Dentistry 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 2.5yo). Childrens, surgical extractions and general dentistry services with Dr Hany Aziz & associate dentists. All other specialised services are with Dr Hany Aziz only.

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*

Day
Month
Year

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 Anesthesia (compliancy issue), extensive treatment
Third molars extraction under General Anesthesia
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 checkup 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 30mins 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.

Mon – Thur	9:00am to 5:00pm
Friday	9:00am to 4:00pm
Sat, Sun	CLOSED