Dentist Referral Form | Dental Artistry

Referral Date

Date of referral(Required)

Referrer Details

Name(Required)

Practice address(Required)

Practice name(Required)

Email address(Required)

Referring to:(Required)

Dear Dental Artistry, please assess/treat the following patient:

Patient Details

Title(Required)

First name(Required)

Last name(Required)

DOB (Date of Birth)(Required)

Phone number(Required)

Email address(Required)

Patient's address(Required)

ACC-related?(Required)

Reason for referral(Required)

Attach Files

Drop files here or

Max. file size: 4 MB.

Please email all relevant historical treatment notes and imagery to reception@dentalartistry.co.nz. If your referral is ACC related, a team member will contact you with the ACC preferred digital template to use for sending patient records.Thank you for your referral.

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Our aim is to provide you with a beautiful smile, a comfortable and efficient bite and excellent oral health

At Dental Artistry we’re dedicated to providing you with exceptional dental treatment in a practice that adheres to the most stringent safety and quality measures.

Our dentists, and patient support team are committed to treating you with kindness and respect.

Tell us about your dental goals and we’ll do our utmost to help you achieve them.

09 524 4541

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Friday	8:30am - 4:00pm
Saturday	9:00am - 3:30pm
Sunday	Closed