×

Please know we will remain open during the festive season but will be closed for the public holidays, and early closure (1pm) on Friday 24th & 31st December. In an emergency, please contact (08) 8364 4311 or message us on Facebook. We wish you a safe and very Merry Christmas and a Happy New Year!

Dentist referral

A copy of the information completed below will be emailed to you as a record.

The Straight Smile Centre welcomes patient referrals from dentists in Adelaide. If you would like to refer a patient to us for orthodontic treatment, please fill in the form below. We will ensure you are kept up-to-date and informed about any treatment plans.

Please fill in all fields marked with *


Patient's details

FOR ANY PHOTOS, XRAYS OR ADDITIONAL INFORMATION YOU WISH TO SUBMIT ALONGSIDE THIS REFERRAL, PLEASE UPLOAD HERE.

Accepted file types: jpg, gif, png, pdf.

Dentist's details

By clicking submit you are agreeing to our privacy policy.

Book your free consultation today

Your free consultation includes free records, x-rays and a digital smile simulation valued at $164.

By clicking ‘book now’ you are agreeing to our privacy policy.