Refer a patient

For general dentists, GPs and specialists. It takes about two minutes.

Your patient stays your patient. We look after the sedation and the agreed treatment, keep you updated, and the patient returns to you for their ongoing care.

Everything you send through this form is encrypted and only seen by our clinical team. Please make sure your patient knows you are referring them and is happy for us to contact them.

Fields marked * are required.

About you

You are a *

General dentistGPDental specialistMedical specialistOther health professional

Your full name *

Practice name and suburb *

Provider number *

Practice phone *

Your email (we send the acknowledgement and updates here) *

Your patient

Patient first name *

Patient last name *

Patient date of birth *

Patient mobile *

Patient email

Parent, guardian or carer name and phone (if relevant)

What they need

Treatment needed (tick any that apply) *

General dental treatment under sedationDifficult or surgical extractionsWisdom teethDental implantsAll-on-X (full arch)Full mouth rehabilitationPeriodontal treatmentBone graft or sinus liftNot sure, please assess

Why sedation? (tick any that apply) *

Dental anxiety or phobiaStrong gag reflexTreatment under local anaesthetic has not workedA lot of treatment needed at onceMedical or special needsThe patient asked for itOther (add detail in clinical notes)

Sedation you have in mind *

IV sedationGeneral anaestheticNot sure, please assess

How soon should we see them? *

RoutineSoon (pain or infection)Urgent, please call me

Clinical notes (teeth involved, what has been tried, anything we should know) *

Medical history

Medical history, medications and allergies (include blood thinners, diabetes, heart or breathing conditions and sleep apnoea, or write None known)

Imaging

X-rays and imaging *

Attached belowSending separatelyThe patient will bring themNone available

Upload x-rays, OPG, CBCT or photos

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After treatment

After treatment, should the patient return to you? *

Yes, they return to me for ongoing careNo, happy for you to continue their care

The patient knows about this referral and is happy for Brisbane Sedation Dentistry to contact them. *

The information in this referral is accurate to the best of my knowledge. *

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