Refer a patient
for orthodontic treatment

Name: Knox Orthodontics
Telephone: (03) 9801 4222

At Knox City Orthodontics, we value the trusted relationships you’ve built with your patients - and we’re here to support them with expert orthodontic care. If you’d like to refer a patient to us, please complete the secure form below. Our team will contact them directly to arrange a consultation.

We believe strongly in collaborative care. You’ll be kept informed throughout the treatment process, and we always emphasise to our patients the importance of continuing their regular visits with you for ongoing general dental care.

Refer a patient
for orthodontic treatment

Treatment type

Private

Independent

Referral date

Patient information

First Name

Last Name

E-Mail

Phone Number

Address

Postal code

Date of Birth

Parent or Guardian Name*

Patient's concern

Medical history and clinical problems

If Known (IOTN)

Referring practitioner*

Referring practitioner phone*

Additional information

Notes

For further information about how we use your data,
please see our privacy policy.

Find us inMelbourne

Knox City Orthodontics is situated in the Knox City Shopping Centre on Burwood Highway in Wantirna South. This is on the corner of Burwood Highway and Stud Rd.

Knox Shopping Centre Suite 501, Level 5 Knox City Office Tower
425 Burwood Highway, Wantirna South
VIC 3152

(03) 9801 4222

Monday: 8:00am to 1:00pm
Tuesday: 8:00am to 6:00pm
Wednesday: 8:00am to 6:00pm
Thursday: 9:00am to 6:30pm
Friday: 8:00am to 5:00pm

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Refer a patient for orthodontic treatment

Patient information

Additional information

Find us inMelbourne

Refer a patient
for orthodontic treatment