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Community Dental referral form

Complete this form if you, your child or a client of your service, would like to access dental treatment through Peninsula Health Community Dental Service

Why you, your child or your client should access dental treatment.

  • A child is over the age of 2 years and has never had a dental check
  • A child has a history of high consumption of sweet food and drinks
  • You have complex medical conditions (for example, you are waiting for heart surgery, you have uncontrolled diabetes, you have cancer and are waiting for radiotherapy, you have renal failure or clients prior to starting bisphosphonate medication.

Who can use Community Dental Services?

Peninsula Health Community Dental program has dental services for everyone either through our public clinics or private clinics. Please call if you would like more information on 03 9784 8184.

Find out more about Community Dental Service treatment costs.

You will be contacted by a member of the Community Dental Services team to confirm this referral.

If you are a referring agency, your client will be contacted to make an appointment with the Community Dental team.