Dentist Referral Letter

Please click on the link below to download a copy of the referral form.

Referral Form

Forms can be faxed to (02) 9262 9597, emailed to or posted to: 

Vintage Surgical Specialists
Unit 3, The Vintage,
281-287 Sussex St
Sydney NSW 2000

Alternatively, fill out the form below:


 Dr Alastair Stevenson
Dr Bruce Austin
Dr Eric Carter

Reason for Consultation

 Third molars
 Oral Pathology/Oral Medicine
 TMJ/Facial Pain
 Salivary Gland

Available Radiographs/models/surgical guides

 Periapical film
 CT/Cone beam scan
 Surgical guide

Please attach your digital Radiographs