Just fill in the form below and leave the rest to us. We'll call and confirm a time.

    Full Name *

    Contact Phone Number*

    Email *

    Address

    You are a:
    New PatientExisting Patient

    Please tick that you have*:
    Healthcare CardGovernment Pension/Benefit StatusMedicare CardPrivate Health InsuranceNone of the Above

    Where did you hear about us?
    Referral - Family/FriendReferral - GPExisting PatientInternet SearchAdvertisement - Newspaper/MagazineAdvertisement - RadioSignageLetterbox FlyerSchool NewsletterPreschool VisitPrivate Health FundLocal Sports ClubOther

    To request an appointment, please complete your preferred dates and times.

    Choice 1

    Time:
    Date:

    Choice 2

    Time:
    Date:

    Choice 3:

    Time:
    Date:

    If you would like to ask any questions or provide information on your concerns please do so in the box below.

    What is your preferred time to be contacted?
    Any TimeMorningAfternoonEvening

    Enter captcha: captcha

     

    Thank you for your appointment request

    Your request was sent successfully.

    We have received your enquiry and will contact you to arrange an appointment time as soon as possible. For urgent enquiries please call us on 9430 3100.

    For all general enquires please use our Contact Form.

    Thank you for contacting us

    Your enquiry was sent successfully.

    We have received your enquiry and will respond to you as soon as possible. For urgent enquiries please call us on 9430 3100.

    Alternatively you can use our Request an Appointment Form.

    Public holiday closure – Queen’s Birthday 2021

    Please note we will be closed on Monday 14 June for the Queen’s Birthday public holiday. We will reopen at 8.30am on Tuesday 15 June.

    For dental emergencies please call the Royal Dental Hospital of Melbourne on 9341 1000 (metro) or 1800 833 039 (outside Melbourne metro).

     

    Share