Referral to Oral Health & Beyond Collective for General Anaesthetic or other Specialised Dentistry Services

This form is for professionals to refer to Oral Health & Beyond Collective for purposes of General Anesthetic or other unique dental services.

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/

Referral for consultation to Dr Hany Aziz for opinion and management of specific dental issue. Oral Health & Beyond Collective has secured regular theatre bookings with Mackay Specialist Day Hospital (from age 2.5yo to adult). Dental services under sedation for dental services for all dentistry services with Dr Hany Aziz.

Referrer Details

Referring Clinic(Required)

Practitioner First Name(Required)

Practitioner Surname(Required)

Patient Details

Patient's First Name(Required)

Patient's Last Name(Required)

Patient's Date Of Birth(Required)
DD slash MM slash YYYY

Parents/Guardians Names (first name & Surname please)

Mobile - best contact number(Required)

Address(Required)
City

Email

Degree of Urgency(Required)

Type of treatment required
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)

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.

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

Drop files here or

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 ext 1. All patients referred will be returned to your practice with a post-operative report for ongoing dental care.

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