Our Services
Our Team
Our Patients
Our Practice
Book
Contact
Resources
Our Services
Book an Appt
Our Patients
Find Us
Our Team
Our Practice
Resources
Contact Us
Call Us:
03 351 7700
Dentist Referral
Patient Information
Name*
Date of Birth*
NHI
Parent/Caretaker Information
Name
Phone*
Email
Other Phone
Referrer Information
Name*
Practice/Clinic*
Email*
Referral Details
Reason for Referral*
If ACC
Claim Number
Date of Accident
Teeth Registered
Attachments
Radiographs, referrals, etc.
Please upload documents (.pdf or .docx) or images only.
Send
Find Us
We’re open Mon-Fri 8am-5pm
214 Papanui Road, Merivale, Christchurch
Ph:
03 351 7700
Email:
hello@brightsmiles.nz
214 Papanui Rd
Merivale
Christchurch
P. 03 351 7700 E.
[javascript protected email address]
Our Services
Our Patients
Our Team
Resources
Book
Find Us
Contact Us
Dentist Referral
© Copyright Priory Management Ltd 2017. All rights reserved.
Website by Spinifex