Provide practice contact details
Include your name, practice, email and phone number so the enquiry can be followed up with you.

For referring dentists
Considering a full arch implant assessment for a patient? Send your practice contact details and a brief reason for enquiry. Keep patient records out of this form and ask how to provide any information needed for the next step.
Referral scope
Use the enquiry to explain what you would like assessed or discussed.
Getting started
Start with a brief enquiry from your practice.
Include your name, practice, email and phone number so the enquiry can be followed up with you.
Give a brief description of the assessment or discussion you are requesting. Avoid identifying or detailed clinical information.
Confirm the appropriate method for sending records and who will arrange any patient contact.
Referral enquiry
Use this form to contact DIHQ about a potential referral. Include your practice details and a brief reason for enquiry. This does not book an appointment or confirm that the referral has been accepted.
Patient pathway
These pages can help patients understand why they are being referred and what their first step may involve.
Referral contact
Use the referral enquiry form to contact DIHQ about the assessment you are considering.