Dentist Referral Letter

Please click on the link below to download a copy of the referral form.

Referral Form

Forms can be faxed to (02) 9262 9597, emailed to or posted to:

Vintage Surgical Specialists
Unit 3, The Vintage,
281-287 Sussex St
Sydney NSW 2000


Alternatively, fill out the form below:


Associate Professor Bruce AustinDr Alastair StevensonDr Eric CarterDr Weber Huang

Reason for Consultation

Third molarsImplantsOrthognathic SurgeryExtractions/dentoalveolarTMJ/Facial PainFacial FracturesOral Pathology Oral MedicineSalivary GlandExpose & Bond

Available Radiographs/models/surgical guides

OPGPeriapical filmCT/Cone beam scanModelsSurgical guide

Please attach your digital Radiographs