Refer a patient

Dentist case referral

Address:

Patrick Wong Prosthodontics

Level 3 BDO Tower

19 Como St. Takapuna

Auckland, NZ 0622

Telephone:

09-416-0085

+64 27 242 2231

Email:

info@prostho.co.nz

Patrick Wong Prosthodontics

referring dentist name

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Thank you for your response. ✨

Referring Dentist Name

Referring Dentist Email

Referring Dentist Contact Number

Dental Practice or Facility

Services Required

Patient details

Patient’s Full Name

Patient’s Date of Birth

Patient’s Contact Number

Patient’s Email Address

Address

Clinical Comments

Please email radiographs, clinical photos and other necessary records to info@prostho.co.nz. Kindly include patient’s name and DOB in email subject.

Please complete the form provided below, and we will promptly reach out to you.

Alternatively, kindly utilize the link below to access the referral form for download. Once completed, please return it via email. Thank you!

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