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Oral Health Contact Centre - Request a call back

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Operating hours of the Contact Centre is from 8am-4.15pm Monday to Friday (excluding public holidays).  One of our operators will aim to contact you within 30 minutes of receiving this request. Requests received outside of these hours will be actioned the next business working day. Please ensure you include a phone number and an email address.

If your think your symptoms are serious or if your situation deteriorates before you can access dental care, go to your local GP or your nearest hospital Emergency Department.  This may include dental trauma/injury, swelling of the face or neck, swelling in the mouth, bleeding from the mouth that won’t stop and/or difficult opening jaw/swallowing.

Contact Details

Title:*
 		First Name:*
 		Surname:*
 
Relationship to Patient:
If the Patient is not yourself.
*
 

 
 

Patient Details

*
*
 		 
*
As per Medicare Card

As per Medicare Card
*
As per Medicare Card

Maiden Name (Name you were born with) and Previous name/s

 
Date of Birth*
*
 
*
 
*
 
*
Address / Town / State
 		*
 

If you require an interpreter, please advise which language spoken.
Do you need an Interpreter:
 
Aboriginality*
 		  
 

Medicare Details

*
 		*
 
Medicare Card Valid To:*
  
 
 
 

Concession Card Details

**Adults patients must populate these fields



Concession Card Valid To:
 

 

Additional Comments



 
Last updated: 22 February 2022
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