NSW Oral Health Specialist Referral Form SMR010741 040714 - health nsw gov 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the patient's details, including their MRN, family name, given name, and date of birth. Ensure all information is accurate for proper processing.
3. Select the appropriate referral center by checking the box next to your choice. Options include Sydney Dental Hospital, Westmead Centre for Oral Health, and John Hunter Hospital.
4. Fill in the patient’s contact information such as home number, mobile number, and work number. Indicate if an interpreter or Aboriginal Liaison Officer is required.
5. Complete the referring practitioner section with their details including type (medical or dental), fax number, email address, and signature.
6. In the patient’s medical and dental information section, provide significant medical history and reason for referral. Check relevant boxes to specify your request.
7. Finally, review all entries for accuracy before saving or exporting your completed form directly from our platform.

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