Referring Doctors

Wisdom Specialist Centre gladly accepts patients from referring doctors.

If you would like to refer someone to our surgery, please send your patient’s x-rays quickly and conveniently with our upload form. We encourage you to use this form in lieu of email, as large file sizes can weigh down your system.

PATIENT REFERRAL FORM

Referring Doctor/Dentist:

Date of Referral:
Field is required!
Field is required!
Patient's First Name
Field is required!
Field is required!
Patient's Last Name:
Field is required!
Field is required!
Patient's Date of Birth:
Field is required!
Field is required!

Reason for Referral

Field is required!
Field is required!
Other
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Field is required!
Notes
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Field is required!
Referred By
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Field is required!
Address
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Field is required!
Provider Number
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Field is required!

Upload X-Rays (Optional)

File types accepted: JPG, JPEG, PNG, GIF, PDF, DICOM. Limit 100MB.
Upload X-Rays
Field is required!
Field is required!

Burwood Rooms

Shop 1/8 Burwood Rd
Burwood NSW 2134
P: (02) 8021 2728
F: (02) 8021 2723
info@wisdomcentre.com.au

    Westmead Rooms

    Suite 40, Daher Centre, 163 – 171
    Hawkesbury Road Westmead,
    NSW 2145
    P: (02) 9633 4552
    F: (02) 9893 8801
    reception@westmeadomfs.com.au